BENEFITS HANDBOOK - KP

Effective September 2019

BENEFITS HANDBOOK FOR PARTNER AND ASSOCIATE PHYSICIANS

Table of Contents2


ABOUT THIS HANDBOOK 21Benefits Programs 21

Summary for Eligible Physicians 22

Summaries of Benefits and Coverage (SBCs) 23

This Handbook Is Neither a Contract nor a Guarantee 23

SUMMARY OF BENEFITS 24

BENEFITS OVERVIEW BY PHYSICIAN CATEGORY 25

HEALTH CARE BENEFITS 46Eligibility and Enrollment 48

Dependent Eligibility 49

Spouse/Domestic Partner Eligibility 49

Enrolling/Deleting Eligible Dependents 50 (also referred to as Family Status Changes)

Dependents of a Deceased Physician 51

Cost 52

Termination of Coverage 53

Termination of Dependent Coverage 53

Coordination of Benefits Coverage 54

Dual Coverage 54

KAISER FOUNDATION HEALTH PLAN 55Eligibility and Enrollment 55

Eligible Dependents 55


Disabled Physicians 56

Coverage Highlights 56

Declining Coverage 58


Conversion of Coverage 59

Limited Continuation of Benefits Available (COBRA) 59

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KFHP SPECIAL DEPENDENT COVERAGE 59Eligibility and Enrollment 59

Special Dependents Over Age 65 60

Dependents of a Retired or Deceased Physician 60

How Special Dependent Coverage Works 61


Loss of KFHP Coverage Following Divorce or Dissolution of 61 Domestic Partnership

Special Dependents May Not Elect Limited Continuation of 62 Benefits (COBRA)

SUPPLEMENTAL MEDICAL COVERAGE 62Eligibility and Enrollment 62



How Benefits Work 63

Covered Charges 63

Exclusions 66

Filing Supplemental Medical Coverage Claims 68

Deductibles and Maximum Benefits for Partner Physicians 68

Deductibles and Maximum Benefits for Associate Physicians 69

Declining Coverage 70


No Conversion 70


COMPREHENSIVE MEDICAL PLAN 71Eligibility and Enrollment 71

How the Plan Works 71

Filing Comprehensive Medical Coverage Claims 72

Annual Deductible 72

Annual Out-of-Pocket Maximum 72

Individual Benefit Maximum 72

Covered Services 72

Services Not Covered 76

Coordination of Benefits 77

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No Conversion 78


ALTERNATE MENTAL HEALTH COVERAGE 79Eligibility and Enrollment 79



What the Benefit Pays 80

Certain Benefits Not Provided to Associate Physicians 81

Exclusions 81

Filing Alternate Mental Health Claims 81

Maximum Benefits for Eligible Partners and Any Associates 82 Hired After January 1, 2011

Maximum Benefits for Any Associate Physicians 82 Hired Before January 1, 2011


No Conversion 83


KFHP EMPLOYEE ASSISTANCE PROGRAM 83

PHYSICIAN WORK-LIFE SOLUTIONS 84

DENTAL COVERAGE 85Eligibility and Enrollment 85


Dental Care Options 86

Summary of Dental Benefits 86

Delta Dental PPO 90

DeltaCare USA 92

United Concordia 95

Continuation of Health Benefits under COBRA 99

HEALTH CARE NOTICES 105

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DISABILITY INCOME BENEFITS 107Sick Leave Pay Programs 108

Disability Income Plans 108

SHORT-TERM DISABILITY INSURANCE 109Eligibility 109

Benefits 109

When Benefits End 110

Definition of Disability 110

Pre-Existing Condition Limitation 110

Successive Periods of Disability 110

Social Security Disability Benefit 110

State Disability 111

Work Incentive Benefit 111

Current Earnings 111

Rehabilitation Program 111

Reasonable Accommodation Benefit Under STD Plan 111

Exclusions 112

Termination of Insurance 112

No Conversion 112

Claims 112

Cost 112

Tax Implications 113

Continuation of Other Benefits 113

Compensation Continuance Program 113

Partial Disability 114

Additional Information for Partner Physicians 114

LONG-TERM DISABILITY INSURANCE 115Eligibility 115

Benefits 115

Benefit Waiting Period 115

Maximum Benefit Period 116



Benefit Reductions 116

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Other Income Benefits 117

Pre-Existing Condition Limitation 117

Benefit Limit for Mental Illness and Substance Abuse 117

Work Incentive Benefit 118

Income Maintenance Benefit (Progressive Illness Enhancement) 119

Current Earnings 119

Rehabilitation Program 119

Reasonable Accommodation Benefit Under LTD Plan 119

Spousal/Registered Domestic Partner Rehabilitation Program 120

Survivor Benefit 120

Exclusions 121

Termination of Insurance 121

Waiver of Premium 121

No Conversion 121

Claims 122

Cost 122


Continuation of Other Benefits While on LTD 122

SUPPLEMENTAL INDIVIDUAL DISABILITY INSURANCE 123(Through UNUM)

Eligibility 123

How the Benefit Works 123

Benefits 124

Elimination Period 125

Maximum Benefit Period 125



Pre-Existing Condition Exclusion 126

Benefit Limit for Mental Illness 126

Exclusions 126

Waiver of Premium 126

Claims 126

Cost 126


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SICK LEAVE AND DISABILITY BENEFITS TIMELINES 127Partner Physicians 127

Associate Physicians (Except Special Category) 128

Special Category Physicians 129

LIFE, ACCIDENT AND OTHER INSURANCE BENEFITS 130Life and Accident Insurance Benefits 131

Combined Coverage Limitations 132

PERMANENTE PROVIDED LIFE INSURANCE 132Eligibility 132

Enrollment 133

Effective Date 133

Coverage Amount 133

Exception to Work Schedule Proration 134

Naming a Beneficiary 134

Coverage After Age 65 134

When Coverage Ends 134

Cost 134

OPTIONAL LIFE INSURANCE 135Eligibility 135

Enrollment 135

Effective Date 136

Benefit Amount 136

Exception to Work Schedule Proration 136

Death Due to Any Cause—Suicide Limitation 136


Coverage After Age 65 137


Accidental Death and Dismemberment 138

Cost 139

Imputed Income 140

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DISABLED PHYSICIANS LIFE INSURANCE 140Eligibility 140

Enrollment 141

Effective Date 141

Benefit Amount 141


Premiums While Disabled 142


Imputed Income 142

SPOUSE/DOMESTIC PARTNER LIFE INSURANCE 142Eligibility 143

Enrollment 143

Effective Date 143

Benefit Amount 143

Death Due to Any Cause —Suicide Limitation 143



Cost 144

LIFE INSURANCE COVERAGE 145Terminal Illness Benefit Option 145

Assignment of Life Insurance Benefits 146

Payment of Benefits 146

Termination 146

Conversion of Life Insurance 147

Portability of Life Insurance 147

Portability to Term Life Option 148

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BUSINESS TRAVEL ACCIDENT INSURANCE 148Who is Eligible 148

When Coverage Begins 148

How Business Travel Accident Insurance Works 148

Exclusions 150

Exclusion for Intoxication 151


No Conversion or Portability Benefit 151

PAID TIME-OFF BENEFITS 152

SICK LEAVE PROGRAMS 153Sick Leave Benefits 153

Acute Sick Leave 154

Accumulated Acute Sick Leave (For Partner Physicians Only) 156

Chronic Sick Leave (For Partner Physicians Only) 156

Accumulated Chronic Sick Leave 157 (For Special Category Physicians Only)

VACATION LEAVE 158Vacation Leave Accrual 158

Borrowing Vacation Leave Time 159

Illness While on Vacation Leave 160

Vacation Leave Sharing Program 160

Termination 160

Former Kaiser Foundation Hospital (KFH) Residents 161

ANNUAL EDUCATIONAL LEAVE 161Eligibility 161

Purpose of the Program 161

How the Program Works 162

Termination 162

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HOLIDAYS 163Eligibility 163

Observed Holidays 163


COMPASSIONATE LEAVE 163Eligibility 163


JURY DUTY 164Eligibility 164


SCPMG LEAVES OF ABSENCE 164

OTHER BENEFITS 166

COMMUTER CHOICE PROGRAM 167Eligibility and Enrollment 167

Tax Savings 167


Limits on Monthly Contributions and Reimbursement 168

Changing Your Contributions 168

Eligible Expenses 168

Ineligible Expenses 169

Rollover of Unused Funds and Termination 169

Claims Administrator 169

FLEXIBLE SPENDING ACCOUNTS 170Who Is Eligible 170

When You Can Enroll 171

Continuing Your Flexible Spending Account 171

How the Spending Accounts Work 171

Rules You Should Know 171

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Tax Considerations 173

When You Leave 173

HEALTH CARE FLEXIBLE SPENDING ACCOUNT 173(For Associate Physicians Only)

Your Contributions 173

Carryover Contributions 174




Prequalification 177

Expenses Not Covered 177

Using Your Healthcare Debit Card 177

Filing a Claim 178

Health Care Flexible Spending Account COBRA Continuation 178

DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT 178(For Associate Physicians Only)

Additional Eligibility Requirements for the Dependent Care FSA 179


Eligible Providers 180


Expenses Not Covered 180

Your Contributions 181


Filing a Claim 182

How Other Benefits Are Affected 182

When Your Participation Ends 183

LONG-TERM CARE INSURANCE 183Through New York Life Insurance Company 183

Eligibility 183

Family Members’ Eligibility 184

Coordination with Other Benefits 184

Through Genworth Life Insurance Company 184

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IDENTITY THEFT PROTECTION 185 (THROUGH IDENTITY GUARD®) Eligibility 185

Enrollment 185

Paying for Membership 186

Spouse/Domestic Partner Coverage 186

Physician & Children 187

Child Enrollment Process 187

Coverage for Child Over Age 18 187

Product Features 188

MORTGAGE LOAN PROGRAMS 188Eligibility 188

How to Apply 188

STUDENT LOAN REFINANCING BENEFITS 188What Else You Might Like to Know 189

PROFESSIONAL LIABILITY COVERAGE 189Eligibility 189

Enrollment 189

Effective Date 190

Description 190

Covered Outside Activities 190

Approval Required for Outside Activities 190

Condition of Coverage 191

Exclusions 191

Termination 191

No Conversion 191

Cost 191

RETIREMENT AND SAVINGS PLANS 192

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SCPMG KEOGH PLAN 194Introduction 194

Eligibility 194

Electing to Participate in the Keogh Plan 195

Important Reminders on Keogh Plan Elections 196

Partner Emeriti Participants 197

Business Administrators and Physicians Who Were Previously 197 Eligible for Another SCPMG Retirement Plan

CONTRIBUTIONS 197Your Contributions to the Keogh Plan 197

Your Contribution Level to the Keogh Plan 198

Your Contribution Percentage to the Keogh Plan 198

Eligible Earnings or Eligible Contributions 198

Federal Limits on Your Keogh Contributions 199

How Contributions Are Made 199

Method to Obtain Maximum Contribution 200

INVESTMENTS 201Published Investment Results 202

Self-Directed Brokerage Accounts in the Keogh Plan 202

Investment Transfers 203

Keogh Plan Account Fees 203

WITHDRAWLS, DISTRIBUTIONS AND ROLLOVERS 204Keogh Plan In-Service Withdrawls 204

Distributions After Separation from Service from SCPMG 204

How Benefits Are Paid 205

When Payments Begin 205

Payment at Your Death 206

Taxes and Rollovers to Other Plans 206

Rollover Contributions to Your Keogh Plan Account 207

MISCELLANEOUS 207Tax Liens, Divorce, Court Orders and Litigation 207

Reports and Statements 207

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Vesting 208

Errors, Claims and Limitations of Rights 208

Unclaimed Benefits Process 208

Top-Heavy Rules 208

Effects on Other Benefits and Social Security 209

CLAIMS, APPEALS AND ADMINISTRATIVE 209 INFORMATION The Right to Amend or Terminate the Keogh Plan 209

General Information About ERISA Claims and Appeals 209

Use of Authorized Representative 209

What is a Claim for Benefits 210

Information Provided by the Keogh Plan If Your Claim is Denied 210

Your Right to Appeal a Denied Claim 211

CLAIMS AND APPEALS 211Claims for Keogh Plan Benefits 211

Statute of Limitations 212

Deadlines for Responding to Your Claims 212

Appeal 212

Deadlines for Responding to Your Appeal 212

Decision on Review 213

Leased Employee Service Claims 213

ADMINISTRATION OF THE KEOGH PLAN 214Service of Legal Process 214

Administrative Powers and Responibilities 214

Keogh Plan Information 215

Separation from Service 215

Recovery of Overpayments 216

Nondiscrimination and Other Applicable Laws 216

Qualified Domestic Relations Order 216

STATEMENT OF ERISA RIGHTS 217

Assistance with Your Questions 218

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SCPMG PHYSICIANS’ 401(K) PLAN 219Introduction 219

Eligibility 219

Enrollment 220

CONTRIBUTIONS 221Your Contributions to the 401(k) Plan 221

Types of 401(k) Plan Contributions 221

Roth Conversions 223

Federal Tax Limits on Your 401(k) Contributions 223

Investments 224

Published Investment Results 226

Investment Transfers 226

401(k) Plan Account Fees 226

LOANS,WITHDRAWLS, DISTRIBUTIONS 226 AND ROLLOVERS 401(k) Plan Loans 226

401(k) Plan In-Service Withdrawals 227

Distributions After You Terminate 228

How Benefits Are Paid 229

When Payments Begin 229

Payment at Your Death 229

Taxes and Rollovers to Other Plans 230

Rollover Contributions to Your 401(k) Plan Account 231

MISCELLANEOUS 231Tax Liens, Divorce, Court Orders and Litigation 231

Reports and Statements 232

Errors, Claims and Limitation of Rights 232

Vesting 232

Unclaimed Benefits Process 233

Table of Contents16


Top-Heavy Rules 233

Effects on Other Benefits and Social Security 233

Military Leave of Absence 233

Extended Educational and Extended Medical Service Leaves 233

CLAIMS, APPEALS AND ADMINISTRATIVE 234 INFORMATION The Right to Amend or Terminate the 401(k) Plan 234


Use of an Authorized Representative 234

What is a Claim for Benefits 234

Information Provided by the Plan If Your Claim is Denied 235


CLAIMS AND APPEALS 236Claims for 401(k) Plan Benefits 236

Statute of Limitations 236


Appeal 237


Decision on Review 237

Leased Employee Service Claims 238

ADMINISTRATION OF THE 401(K) PLAN 239Service of Legal Process 239

Administrative Powers and Responibilities 239

401(K) Plan Information 241

Separation from Service 240


Nondiscrimination and Other Applicable Laws 241


STATEMENT OF ERISA RIGHTS 242


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EARLY SEPARATION PROGRAM 244Eligibility 244

Application and Approval Required 244

Benefit Amount 245

Early Separation and Sick Leave 245

Transferring to Partner Emeritus Status 245

Taxes 245

Program May Be Amended or Terminated 246

Other Early Separation Program Benefits 246

PARTNER EMERITUS CATEGORY 246 (IMPACT TO BENEFITS) Partner to Partner Emeritus 246

Partner to Partner Emeritus A (No Keogh Contributions) 247

Partner to Partner Emeritus K (Keogh Contributions) 247

Eligibility Criteria for Benefits 248

Impact to SCPMG Physicians’ 401(k) Plan 248

Impact to Common Plan 248

Impact to Early Separation Retirees 249

LEAVING SCPMG 250Health Care Benefits 251

Life Insurance 253

Benefits When You Leave SCPMG 254

CLAIMS, APPEALS AND ADMINISTRATIVE 266 INFORMATION The Right to Amend or Terminate the Plans 267

Disputes for Benefit Plans Not Governed by ERISA 267

Health and Welfare Eligibility and Enrollment Disputes 268


Use of an Authorized Representative 268

What Is a Claim for Benefits 269

Information Provided by the Plan If Your Claim Is Denied 270


Health Plan Claims and Appeals 271

Table of Contents18


Types of Claims 272

Deadlines for Responding to Each of the Four Types of 273 Health Care Claims

Urgent Care Claims 273

Pre-Service Claims 274

Post-Service Claims 275

Concurrent Care Claims 275

Reduction or Termination of Previously-Approved Concurrent Care 275

Extension of Previously-Approved Concurrent Care 276

How to Appeal if Your Claim for Health Benefits Is Denied 276

Deadlines for Responding to Your Appeal for Each of the 277 Four Types of Health Care Claims

Urgent Care Claims 277

Pre-Service Claims 277

Post-Service Claims 277

Concurrent-Care Claims 277

MEDICAL PLANS CLAIMS AND APPEALS 278Kaiser Foundation Health Plan 278

Emergency Claims 278

Where to File Your KFHP (including Emergency) Claims 278

Appeals 278

Arbitration Agreement 279

Member Satisfaction Grievance Process 279

ADDITIONAL INFORMATION FOR CERTAIN 280 OTHER MEDICAL CLAIMS AND APPEALS Claims 280

Continuing Claims 281

Appeals 281

DENTAL PLANS CLAIMS AND APPEALS 281Delta Dental or United Concordia 281

If Your Claim Is Denied 282

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EMPLOYEE ASSISTANCE PROGRAM (EAP) CLAIMS AND APPEALS 282KFHP or Physician Work-Life Solutions 282

HEALTH CARE FSA CLAIMS AND APPEALS 282Filing A Claim 282

Appeals for Health Care Flexible Spending Account Claims 283

DISABILITY PLANS CLAIMS AND APPEALS 284Claims 284

Deadlines for Responding to Your Claims for Disability Benefits 285

Appeals 285

Deadlines for Responding to Your Appeal for Disability Benefits 286

What to Do About a Denial After Final Review 286

Retiree Benefits Claims and Appeals 286

Retiree Health and Welfare Eligibility Claims 287

Retiree Health and Welfare Benefits Eligibility Appeals 287

RETIREE MEDICAL CLAIMS AND APPEALS 288Claims 288

Appeals 288

MEDICARE PART B REIMBURSEMENT 288Filing a Claim: Medicare Part B 288

Appeals for Denied Retiree Medicare Part B Claims 289

RETIREMENT PLAN BENEFITS CLAIMS AND APPEALS 290Defined Contribution Plan Claims for the Keogh and 401(k) Plans 290

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GENERAL INFORMATION ABOUT OTHER TYPES OF CLAIMS AND APPEALS 290Life Insurance, Retiree Life Insurance, Accidental Death and 290 Dismemberment, Business Travel Accident, and Long-Term Care Claims


How to Appeal a Denial of Your Initial Claim 291


What to Do About a Denial After Final Review 293

ADMINISTRATION OF THE PLANS 293Service of Legal Process 294

Administrative Powers and Responsibilities 294

Welfare and Retirement Plans 294

Separation From Service 299

Third Party Responsibility 299

Obligations of the Eligible Physician and/or Covered Dependent 300

No Duty to Independently Sue or Intervene 301



Qualified Medical Child Support Order 303

Statement of ERISA Rights 303


GLOSSARY OF TERMS 306

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ABOUT THIS HANDBOOK

This document, referred to as the “Benefits Handbook” or the “Handbook,” summarizes the benefits, which were in effect as of the date on the front cover, for certain eligible physicians of Southern California Permanente Medical Group (SCPMG) who qualify for benefits, and their eligible dependents.

The Employee Retirement Income Security Act of 1974 (ERISA), a federal law, governs those benefit plans identified in the Claims, Appeals, and Administrative Information section of this Handbook, effective as of this date on the front of this Handbook. The list of benefit plans subject to ERISA may change from time-to-time. For the benefit plans governed by ERISA, this Benefits Handbook serves as your Summary Plan Description (SPD). This Handbook describes many but, not all, details of the benefit plans. The terms and conditions of the benefits subject to ERISA are specified in the official plan documents, insurance contracts, or service agreements. In case of any omission or conflict between what is written in this SPD and in the official plan documents, insurance contracts, or service agreements, the official plan documents, contracts, or agreements, as applicable, always govern.

For those benefit programs that are not subject to ERISA, (those benefit programs not included in the list of benefit plans subject to ERISA in the Claims, Appeals, and Administrative Information section of this Handbook, effective as of this date on the front of this Handbook), in the case of any omission or conflict in this Handbook, the official plan document or agreement (if any), the SCPMG Partnership Agreement, SCPMG Rules and Regulations, and the minutes of SCPMG’s Board of Directors and the minutes of the Medical Directors, as applicable, always govern. The benefits described in this Benefits Handbook may be modified or eliminated at SCPMG’s sole discretion. You will be advised of any significant changes in your benefits.

Benefits Programs

The benefits featured in this Handbook are listed below:

• Health Care Benefits

– Kaiser Foundation Health Plan (KFHP)

– Special Dependent Plan

– Supplemental Medical Plan

– Comprehensive Medical Plan

– Alternate Mental Health Plan

– KFHP Employee Assistance Program

– Physician Work-Life Solutions

– Dental Coverage

• Disability Income Benefits

– Short-Term Disability Insurance

– Long-Term Disability Insurance

– Supplemental Individual Disability Insurance

22


• Life, Accident and Other Insurance Benefits

– Permanente Provided Life Insurance

– Optional Life Insurance

– Disabled Physicians Life Insurance

– Spouse/Domestic Partner Life Insurance

– Life Insurance Coverage

– Business Travel Accident Insurance

• Paid Time-Off Benefits

– Sick Leave Programs

– Vacation Leave

– Annual Educational Leave

– Holidays

– Compassionate Leave

– Jury Duty

– Leaves of Absence

• Other Benefits

– Commuter Choice Program

– Flexible Spending Accounts

– Long-Term Care Insurance

– Identity Theft Protection

– Mortgage Loan Programs

– Student Loan Refinancing Benefits

– Professional Liability Coverage

• Retirement and Savings Plans

– SCPMG Keogh Plan

– SCPMG Physicians’ 401(k) Plan

– SCPMG Early Separation Program

Summary for Eligible Physicians

The summaries provided in this Handbook reflect Southern California Permanente Medical Group (SCPMG) benefits for eligible current and former Associate and Partner Physicians only. For more information regarding retiree benefits, refer to the Retiree Benefits Handbook. There are other summaries available for the benefits provided to other salaried and hourly employees of SCPMG.

Please note: Benefits are subject to change; therefore, the most recent changes may not be reflected in this Handbook until it is updated again. If you have any questions, contact Permanente Human Resources Shared Services at 1-877-608-0044.

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Summaries of Benefits and Coverage (SBCs)

As a result of the Patient Protection and Affordable Care Act, insurance companies and group health plans are now required to provide consumers with concise documents detailing, in plain language, simple and consistent information about health plan benefits and coverage. These documents will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions. The Summaries are available on the SCPMG Physician Portal at scpmgphysician.kp.org. Refer to the Benefits page under the HR & Financials tab.

This Handbook Is Neither a Contract nor a Guarantee

While SCPMG provides a benefit program for its eligible physicians and their eligible dependents, this benefit program does not constitute a contract of employment with SCPMG, nor does it mean future employment or Partnership with SCPMG is guaranteed.

Permanente Human Resources

Permanente Human Resources (PHR) is the human resources team supporting all physicians within the Southern California Permanente Medical Group (SCPMG). PHR is comprised of several departments that support SCPMG physicians throughout their career:

• Professional Recruitment – facilitates physician selection and hiring process

• Group & Provider Enrollment Unit – facilitates enrollment in federal and state programs

• Board Support – supports the SCPMG Board of Directors

• Benefits – administers SCPMG benefit plans for health care, life insurance, retirement, post-retirement benefits, leaves, and paid time off

• PHR Systems – maintains SCPMG system applications

• Total Compensation – manages HR operations, strategic compensation, and quality review programs

• PHR Shared Services – contact for questions on SCPMG benefits, compensation, retirement, and system applications

• Physician Relations – addresses physician performance and behavior issues that may expose SCPMG to liability

PHR leadership and staff are based out of the SCPMG Regional Offices in Walnut Center in Pasadena, California. PHR also has local representatives onsite at each of the Southern California medical centers.

For any questions pertaining to physician benefits, please contact PHR Shared Services at 1-877-608-0044 or email [email protected].

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SUMMARY OF BENEFITS

Physician Benefit Category Category Overview

Partner Classification

Partner In general, a physician who has been elected into the partnership. Multiple categories of Partner Physicians exist.

Associate Classification

Full-Time Regular A physician employed by SCPMG who works 8/10 or greater as defined in the SCPMG Partnership Agreement/Rules and Regulations and does not participate in an outside medical practice for personal monetary gain.

Full-Time Special A physician employed by SCPMG who works 8/10 or greater and does not participate in an outside medical practice for monetary gain and is not eligible for partnership. A physician may also be placed in this category for administrative reasons.

Special Category A physician who has been employed by SCPMG for a minimum of three full years and, because of age or administrative reasons, has been deemed ineligible for partnership. A physician may also be placed in Special Category for limited periods of time under certain circumstances.

Part-Time Regular (Partnership Track)

A physician who is regularly employed by SCPMG at least 5/10 but less than 8/10. This physician is not permitted to have an outside practice or professional obligations outside SCPMG and may be considered for partnership after meeting the requirements as listed in the SCPMG Partnership Agreement.

Part-Time Special Category A physician who has been employed by SCPMG at least 5/10 but less than 8/10 and has worked for a minimum of six full years and, because of age or administrative reasons, has been deemed ineligible for partnership. A physician may also be placed in this Special Category for an alternative limited period of time under certain circumstances.

Part-Time Special (Not on Partnership Track)

A physician who is regularly employed by SCPMG at least half time (5/10 but less than 8/10). This physician may be permitted to have an outside medical practice or professional obligations outside of SCPMG and is not eligible for partnership consideration.

Refer to the current SCPMG Partnership Agreement/Rules and Regulations for a more detailed description of these physician benefit classes. A Regular Per Diem Physician—a physician who works for hourly pay, may have an outside medical practice, and who receives no other Medical Group benefits except for Paid Sick Leave under California Healthy Workplaces Healthy Families Act of 2014—is not eligible for most of the benefits and programs described in this Handbook, including health care benefits. A retired SCPMG physician with Partner Emeritus Per Diem status may be entitled to retiree benefits as well as Paid Sick Leave under California Healthy Workplaces Healthy Families Act of 2014.

This Handbook does not describe benefits or programs that may be available to postgraduate trainee physicians, Podiatric Physicians and Surgeons, or physicians (and former physicians) not classified as eligible current, former Associate or Partner Physicians.

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BENEFITS OVERVIEW BY PHYSICIAN CATEGORY

PARTNER

This physician category may have any work schedule.

Benefits DescriptionCoverage Effective Date* Cost to Physician Comments

Health Care Coverage

Kaiser Foundation Health Plan¹ ²

Continues Imputed income Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available

Special Dependent Date of enrollment 100% paid by physician or by direct bill to participant

Coverage that may be purchased for certain individuals not eligible to participate as your dependents under other coverage. Conversion to individual plan may be available

Supplemental Medical¹ ² Continues Imputed income Coverage for spouse/domestic partner and dependent children up to age 26. Continuation coverage may be available.

Comprehensive Medical¹ ²

(Only on an approved sabbatical)

May elect if on extended leave (educational/ medical/military)

Imputed income You may elect this coverage if you are on an approved extended leave (educational/ medical/military) and reside outside of a Kaiser Permanente service area

Alternate Mental Health¹ ² Continues Imputed income Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available

Dental¹ ² Continues Imputed income Coverage for spouse/domestic partner and dependent children up to age 26. Continuation coverage may be available.

Disability Coverage

Short-Term Disability¹ Not eligible -----

Compensation Continuance

Upon election to Partnership

Taxable as ordinary income

60% of monthly base or gross compensation up to 22 weeks

Long-Term Disability¹ Upon election to partnership

Imputed income Premiums paid by SCPMG. Benefits received are not taxable.

Supplemental Individual Disability Insurance¹

Date of enrollment 100% paid by physician

May purchase during specified enrollment period. May be subject to underwriting

Life, Accident and Other Insurance Benefits

Permanente Provided Life¹ ³

After 3 years of qualifying service

Imputed income Eligible for 100% of base annual compensation after 3 years of qualifying service, 200% after 5 years of credited service, 300% after 15 years of credited service

Optional Life¹ ³

(Includes AD&D)

Date enrollment formed signed, upon approval by insurance company

Physician paid, premium rate based upon age

May purchase up to 600% of base annual compensation. Generally, proof of insurability required for all amounts over 200% within 60 days of enrollment period. Generally, after 60 days, proof required for all amounts

Spouse/Domestic Partner Life Insurance¹

Date of enrollment Physician paid, premium rate based upon spouse/ domestic partner’s age

May purchase up to $500,000 life insurance for spouse/domestic partner. Generally, proof of insurability required for benefit over $100,000 within 60 days of enrollment period. Generally, after 60 days, proof required for all amounts

Business Travel Accident¹ Continues None While traveling on SCPMG business not commuting between home and work

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Retiree Life¹

(See Retiree Benefits Handbook)

If eligible, upon retirement

Imputed income $50,000 death benefit after retirement, if you meet eligibility requirements and not eligible for Tapered Life

Tapered Life¹



Imputed income Must have been enrolled in Optional Life prior to December 31, 1990 and meet eligibility requirements

Paid Time-Off BenefitsAll time-off benefits are prorated to the work schedule

Acute Sick Leave Continues Taxable as ordinary income

22 days per year

Accumulated Acute Sick Leave

Upon election to Partnership


20% of unused Acute Sick Leave balance transfers to Accumulated Acute on anniversary date. May reaccumulate. Maximum 44 days

Chronic Sick Leave Maximum 528 days Taxable as ordinary income

Balance available upon election to Partnership. Does not reaccumulate

Accumulated Chronic Sick Leave

Not eligible -----

Vacation Leave Continues Taxable as ordinary income

See Handbook for accrual schedule

Educational Leave Continues Taxable as ordinary income

5 days per year (max accrual is 20 days)

Holidays and Holiday Pay Continues Taxable as ordinary income

See Handbook for observed holidays and rates of pay

Compassionate Leave Continues Taxable as ordinary 5 days (upon approval)

Jury Duty Continues None Maximum of 10 days of paid Jury Duty leave in any 5 consecutive year period. Additional time for Jury Duty must be taken as vacation leave or a leave of absence. Must provide copies of all court correspondence to Chief of Service and Area Medical Director

Other Leaves Varies Taxable as ordinary income

Subject to eligibility requirements

Other Benefits

Commuter Choice Program

Not eligible -----

Health Care Spending Account¹

Not eligible -----

Dependent Care Spending Account

Not eligible -----

Long-Term Care Insurance¹ (through New York Life)

Enrollment closed to new applicants

May continue to pay premiums if enrolled

100% paid by physician

Coverage is no longer available. However, if you purchased a NYL policy, you may continue to pay premiums

Long-Term Care Insurance ¹ (through Genworth)




Coverage is no longer available. However, if you purchased a Genworth policy, you may continue to pay premiums

(continued)

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Identity Theft Protection Program


May enroll or discontinue enrollment at any time. Based on reasonable administrative timelines

Mortgage Loan Program Continues Varies See Handbook for details

Student Loan Refinancing Continues 100% paid by physician

See Handbook for details

Professional Liability Coverage

Continues None Date-of-occurrence basis

Physician Work-Life Solutions¹

Continues Imputed income

Retirement Plans

Common Plan 4 Service time accrual continues


Generally, begin accruing service time upon Associate Physician hire date. Generally vested following 10 years of qualifying service if work schedule is at least 5/10

Keogh Plan¹ Upon Partnership 100% physician contribution

Contribution level begins immediately upon election to Partnership. Contribution level determined by an election that is generally made by the physician within 180 days after becoming an Associate Physician. However, special election rules apply such that the Keogh Plan election may be different in some cases

The 401(k) Plan for SCPMG and TSPMG¹

Continues 5 100% physician contribution

May enroll or discontinue contributions at any time. Defer from 1 - 75% of compensation on a Traditional Pre-Tax, Roth 401(k) After-Tax or Traditional After-Tax basis up to annual federal limits

Early Separation Program Must be at least age 58


May retire between ages 58 to 65. Requires at least 10 years of qualifying service with SCPMG and a 1 year notice to the SCPMG Board of Directors

* Coverage Effective Date: If the chart reads “continues,” this implies no change in coverage when a physician moves from one physician category to another.

1 Benefit plan subject to ERISA, as of 4/2019. Subject to change from time-to-time. Benefit programs without a ¹ are not subject to ERISA, as of 4/2019. Employee Assistance Program (EAP) under Physician Work-Life Solutions are subject to ERISA, but other benefits under Physician Work-Life Solutions are not.

2 Domestic partner benefits result in imputed income to physician. Imputed income may apply in other circumstances. Refer to the details in this Handbook or contact PHR Shared Services for more information.

3 Combined coverage amounts of Permanente Provided Life plus Optional Life cannot exceed 600% of Base Annual Compensation or up to a maximum of $2,500,000.

4 Subject to the terms of the Common Plan. The Common Plan is provided by KFHP, not by SCPMG. References to the Common Plan in this Handbook are based on SCPMG’s understanding of the rules and are for your convenience only since only KFHP (and not SCPMG) can change and interpret the Common Plan. Refer to the Common Plan Summary Plan Explanation for information on the Common Plan. In the event of any conflict between anything in this Handbook or any other SCPMG documents and the Common Plan, the terms of the Common Plan will always control.

5 Generally, an eligible physician may enroll 180 days after becoming an Associate Physician. However, special rules apply. Refer to the SCPMG Physicians’ 401(k) Plan section of this Handbook for further information.

28


FULL-TIME REGULAR (Associate) 8/10 – 10/10 This work schedule must be maintained to remain in this status. If working less than 8/10, you must transfer to part time. Associate Physicians on a 3-year Partnership track are in this category.

Benefit DescriptionCoverage Effective Date* Cost to Physician Comments


Kaiser Foundation Health Plan¹

Date of hire None² Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available



Supplemental Medical¹ Date of hire None² Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available

Comprehensive Medical¹ Not eligible -----

Alternate Mental Health¹ Date of hire None² Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available

Dental¹ First of month after date of hire

None² Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available

Disability Coverage

Short-Term Disability¹ Date of hire Imputed income Enrollment automatic upon hire date. Company-paid benefits are added to your taxable income and short-term disability benefits are not taxable when received


Not eligible -----

Long-Term Disability¹ Date of hire 100% paid by physician

Must elect enrollment during new hire 60-day enrollment period. Enrollment not available after 60- day enrollment period. Benefits received are not taxable







Coverage over $50,000 is imputed income

Eligible for 100% of base annual compensation after 3 years of qualifying service, 200% after 5 years of credited service, 300% after 15 years of credited service

Optional Life¹ ³

(Includes AD&D)


Premium rate based upon age



Date of purchase Premium rate based upon spouse/ domestic partner’s age


(continued)

29



Business Travel Accident¹ Date of hire None While traveling on SCPMG business not commuting between home and work

Retiree Life¹



None $50,000 death benefit after retirement, if you meet eligibility requirements and not eligible for Tapered Life

Tapered Life ¹




Must have been enrolled in Optional Life prior to December 31, 1990 and meet eligibility requirements


Acute Sick Leave Date of hire None If hired prior to July 1, 2014, up to 22 days per year, prorated to work schedule. During first year, Acute Sick Leave (ASL) accrues biweekly. If hired on or after July 1, 2014, up to 10 days per year, prorated to work schedule. During first year, ASL accrues biweekly during first 6 months as an Associate Physician


Not eligible -----

Chronic Sick Leave Not eligible -----


Not eligible -----

Vacation Leave Date of hire None See Handbook for accrual schedule

Educational Leave After 1 year None 5 days per year (max accrual is 20 days)

Holidays and Holiday Pay Date of hire None See Handbook for observed holidays and rates of pay

Compassionate Leave Date of hire None 5 days (upon approval)

Jury Duty Date of hire None Maximum of 10 days of paid Jury Duty leave in any 5 consecutive year period. Additional time for Jury Duty must be taken as Vacation Leave or a Leave of Absence. Must provide copies of all court correspondence to Chief of Service and Area Medical Director

Other Leaves Varies ----- Subject to eligibility requirements

Other Benefits



Election to participate may be changed monthly for the following month



Date of hire, annual open enrollment or a qualifying event




Long-Term Care Insurance¹

(through New York Life)


In some cases, may be eligible if previously enrolled in a timely manner



(continued)

30






Mortgage Loan Program Date of hire Varies See Handbook for details

Student Loan Refinancing Date of Hire 100% paid by physician



Date of hire None Date-of-occurrence basis


Date of hire None

Retirement Plans

Common Plan4 Date of hire Taxable as ordinary income

Generally, begin accruing service time upon hire as Associate Physician. Generally vested following 10 years of qualifying service if work schedule is at least 5/10




See below5 100% physician contribution


Early Separation Program Not eligible -----







31


FULL-TIME SPECIAL (Associate) 10/10

This work schedule must be maintained to remain in this status. Working 8/10 or 9/10 schedule may be approved by Chief of Service and Area Medical Director after 2 years of service. If working less than 8/10, you must transfer to part time.







Supplemental Medical¹ Date of hire None² Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available


Alternate Mental Health¹ Date of hire None² Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available

Dental¹ First of month after date of hire

None² Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available

Disability Coverage



Not eligible -----

Long-Term Disability¹ Date of Hire 100% paid by physician

Must elect enrollment during new hire 60-day enrollment period. Enrollment not available after 60-day enrollment period. Benefits received are not taxable








Eligible for 100% of Base Annual Compensation after 3 years of qualifying service, 200% after 5 years of credited service, 300% after 15 years of credited service

Optional Life¹ ³

(Includes AD&D)


Premium rate based upon age. Coverage over $50,000 is imputed income

May purchase up to 600% of Base Annual Compensation. Generally, proof of insurability required for all amounts over 200% within 60 days of enrollment period. Generally, after 60 days, proof required for all amounts


Date of enrollment Premium rate based upon spouse/ domestic partner’s age

May purchase up to $500,000 life insurance for spouse/ domestic partner. Generally, proof of insurability required for benefit over $100,000 within 60 days of enrollment period. Generally, after 60 days, proof required for all amounts


(continued)

32



Retiree Life¹




Tapered Life¹






Acute Sick Leave Date of hire None If hired prior to July 1, 2014, up to 22 days per year, prorated to work schedule. During first year, Acute Sick Leave (ASL) accrues biweekly

If hired on or after July 1, 2014, up to 10 days per year, prorated to work schedule. During first year, ASL accrues biweekly during first 6 months as an Associate Physician


Not eligible -----



Not eligible -----


Educational Leave Upon approval None 5 days per year (max accrual is 20 days)





Other Benefits














Coverage is no longer available. However, if you purchased a NYL policy you may continue to pay premiums





Student Loan Refinancing Date of hire 100% paid by physician


(continued)

33






Date of hire None

Retirement Plans

Common Plan4 Service time accrual continues

None Generally, begin accruing service time upon hire as Associate Physician. Generally vested following 10 years of qualifying service if work schedule is at least 5/10

Keogh Plan1 Upon Partnership 100% physician contribution


The 401(k) Plan for SCPMG and TSPMG1

See below 5 100% physician contribution









34


SPECIAL CATEGORY (Associate) 8/10 – 10/10

This work schedule must be maintained to remain in this status. If working less than 8/10, you must transfer to part time. Three-year maximum in this category unless in category prior to 1988. If hired after February 2, 2007, you can only remain in this category for 2 years.




Continues None² Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available



Supplemental Medical¹ Continues None² Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available


Alternate Mental Health¹ Continues None² Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available

Dental¹ Continues None² Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available

Disability Coverage

Short-Term Disability ¹ Date of hire Imputed income Enrollment automatic upon hire date. Company-paid benefits are added to your taxable income and short-term disability benefits are not taxable when received


Not eligible -----

Long-Term Disability¹ Date of purchase 100% paid by physician

Must elect enrollment during new hire 60-day enrollment period. Enrollment not available after 60-day enrollment period. Benefits received are not taxable








Eligible for 100% of Base Annual Compensation after 3 years of qualifying service, 200% after 5 years of credited service, 300% after 15 years of credited service

Optional Life¹ ³

(Includes AD&D)



May purchase up to 600% of Base Annual Compensation. Generally, proof of insurability required for all amounts over 200% within 60 days of enrollment period. Generally, after 60 days, proof required for all amounts

(continued)

35





May purchase up to $500,000 life insurance for spouse/ domestic partner. Generally, proof of insurability required for benefit over $100,000 within 60 days of enrollment period. Generally, after 60 days, proof required for all amounts


Retiree Life¹




Tapered Life¹






Acute Sick Leave Continues None If hired prior to July 1, 2014, up to 22 days per year, prorated to work schedule. During first year, Acute Sick Leave (ASL) accrues biweekly



Not eligible -----



Continues None

Vacation Leave Continues None See Handbook for accrual schedule

Educational Leave Continues None 5 days per year (max accrual is 20 days)

Holidays and Holiday Pay Continues None See Handbook for observed holidays and rates of pay

Compassionate Leave Continues None 5 days (upon approval)

Jury Duty Continues None Maximum of 10 days of paid Jury Duty leave in any 5 consecutive year period. Additional time for Jury Duty must be taken as Vacation Leave or a Leave of Absence. Must provide copies of all court correspondence to Chief of Service and Area Medical Director


Other Benefits















(continued)

36












Continues None

Retirement Plans

Common Plan 4 Date of hire Taxable as ordinary income

Generally, begin accruing service time upon hire as Associate Physician. Generally vested following 10 years of qualifying service if work schedule is at least 5/10

Keogh Plan1 Upon Partnership 100% physician contribution


The 401(k) Plan for SCPMG and TSPMG1


May enroll or discontinue contributions at any time.Defer from 1 - 75% of compensation on a Traditional Pre-Tax, Roth 401(k) After-Tax or Traditional After-Tax basis up to annual federal limits








37


PART-TIME REGULAR (PARTNERSHIP TRACK) 5/10 – 7/10

This work schedule must be maintained to remain in this status. If working less than 5/10, you must transfer to Per Diem.





Special Dependent Not eligible -----

Supplemental Medical¹ Not eligible -----


Alternate Mental Health2 Eligible 50% paid by physician

Coverage for spouse/domestic partner and dependent children up to age 26. Continuation coverage may be available

Dental2 Eligible 50% paid by physician

Coverage for spouse/domestic partner and dependent children up to age 26. Continuation coverage may be available

Disability Coverage



Not eligible -----

Long-Term Disability¹ Date of enrollment 100% paid by physician










Optional Life¹ ³

(Includes AD&D)








Retiree Life¹




(continued)

38



Tapered Life¹









Not eligible -----



Not eligible -----


Educational Leave Not eligible -----





Other Benefits



















Student Loan Refinancing Date of hire 100% physician contribution





Date of hire None

(continued)

39



Retirement Plans















40


PART-TIME SPECIAL CATEGORY (ASSOCIATE) 5/10 – 7/10

A physician who has been employed by SCPMG at least 5/10 but less than 8/10 and works for a minimum of 6 full years and, because of age or administrative reasons, has been deemed ineligible for Partnership. A physician may also be placed in Special Category for limited periods of time under certain circumstances.





Continues None² Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available




Alternate Mental Health¹ 2 Continues if enrolled 50% paid by physician

Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available

Dental¹ 2 Continues if enrolled 50% paid by physician

Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available

Disability Coverage

Short-Term Disability¹ Continues Imputed income Company-paid benefits are added to your taxable income and short-term disability benefits are not taxable when received


Not eligible -----

Long-Term Disability¹ Continues if enrolled 100% paid by physician

Benefits received are not taxable









Optional Life¹ ³

(Includes AD&D)








Retiree Life¹




(continued)

41



Tapered Life¹





Paid Time-Off Benefits All time-off benefits are prorated to the work schedule

Acute Sick Leave Continues None If hired prior to July 1, 2014, up to 22 days per year, prorated to work schedule. During first year, ASL accrues biweekly



Not eligible -----



Date of election into category

----- 100% of unused Acute Sick Leave balance transfers to Accumulated Chronic Sick Leave on anniversary date. May reaccumulate. Maximum 66 days

Vacation Leave Continues None See Handbook for accrual schedule


Holidays and Holiday Pay Continues None See Handbook for observed holidays and rates of pay

Compassionate Leave Continues None 5 days (upon approval)

Jury Duty Continues None Maximum of 10 days of paid Jury Duty leave in any 5 consecutive year period. Additional time for Jury Duty must be taken as Vacation Leave or a Leave of Absence. Must provide copies of all court correspondence to Chief of Service and Area Medical Director


Other Benefits



















Student Loan Refinancing Continues 100% paid by physician


(continued)

42






Date of hire None

Retirement Plans



Keogh Plan¹ Upon Partnership ----- Contribution level begins immediately upon election to Partnership. Contribution level determined by an election that is generally made by the physician within 180 days after becoming an Associate Physician. However, special election rules apply such that the Keogh Plan election may be different in some cases


See below5 100% physician contribution









43


PART-TIME SPECIAL (NOT ON PARTNERSHIP TRACK) 5/10 – 7/10





Eligible Physician pays 50%² May purchase at 50% discounted rate. Coverage for spouse/domestic partner and eligible dependent children up to age 26. Continuation coverage may be available




Alternate Mental Health¹ Not eligible -----

Dental¹ Not eligible -----

Disability Coverage



Not eligible -----

Long-Term Disability¹ Date of hire 100% paid by physician










Optional Life¹ ³

(Includes AD&D)








Retiree Life¹




Tapered Life¹





(continued)

44







Not eligible -----



Not eligible -----







Other Benefits
























Date of hire None

(continued)

45



Retirement Plans















46


HEALTH CAREBENEFITS

SECTION I:

46

HEALTH CARE BENEFITS 47SECTION: I


This section of the Handbook, which also serves as the Summary Plan Description (SPD) for the health care benefit programs that are subject to the Employee Retirement Income Security Act (ERISA), provides a summary of the SCPMG-sponsored health and welfare benefit programs for eligible physicians, including coverage for Kaiser Foundation Health Plan, Special Dependent, Supplemental Medical, Comprehensive Medical, Alternate Mental Health, the Employee Assistance Programs and Dental.

This Handbook provides many, but not all, of the details of these benefit programs. The terms and conditions of these health care benefits are specified in the official plan documents, insurance contracts, or service agreements. In case of any omission or conflict between what is written in this Handbook and in the official plan documents, insurance contracts, or service agreements, the official plan documents, contracts or agreements, as applicable, always govern.

HEALTH CARE BENEFITS

SCPMG’s health care benefits are designed to provide you and your eligible dependents with coverage for eligible health care expenses. The following coverage options may be available to you as an active physician:

• Kaiser Foundation Health Plan (KFHP) provides coverage for medical care—from routine checkups to major surgery

• Special Dependent is considered a feature within KFHP and enables you to provide medical care for certain individuals who may not qualify as dependents under other medical care coverage

• Supplemental Medical can provide benefits for some medical services that may not be available under KFHP or that exceed KFHP coverage limits

• Comprehensive Medical provides benefits for you while you are on extended educational/medical/military service leave outside of a Kaiser Permanente service area when you cannot avail yourself of or do not choose KFHP. It is not a substitute for KFHP coverage

• Alternate Mental Health provides you with benefits for inpatient and outpatient treatment for mental health and substance abuse through any facility or provider

• Employee Assistance Programs provide you and your eligible dependents with confidential counseling, short-term problem solving and referral services

• Dental provides you a choice of dental benefit options: Delta Dental PPO, DeltaCare USA and United Concordia (DHMO)



Eligibility and Enrollment

You and your eligible dependents may enroll in health care benefits. Your health care benefits consist of the following benefit coverage options:

• Kaiser Foundation Health Plan (KFHP)

• Special Dependent

• Supplemental Medical

• Comprehensive Medical Care (only for Partner Physicians on an approved extended educational leave, medical service leave, military leave and retirees)

• Alternate Mental Health

• Dental

Each benefit option is described later in this Handbook. You can obtain the appropriate enrollment forms on the SCPMG Physician Portal at scpmgphysician.kp.org or by calling PHR Shared Services 1-877-608-0044. Although enrollment in health care benefits for many physicians is automatic, you need to complete the enrollment form to indicate any eligible dependents you wish to enroll and to select a dental option. If you do not choose a dental option by the 30th day after your eligibility date, you will be enrolled in Delta Dental PPO.

KFHP coverage and, if eligible, Supplemental Medical and Alternate Mental Health coverage, begins on your date of hire provided you are actively at work on that date and you timely enroll for coverage. Coverage under Special Dependent or Comprehensive Medical is effective on the first of the month following receipt of your properly completed enrollment application forms. Your dental coverage is effective on the first day of the month following your date of hire or, if later, the date you first become eligible. If your date of hire is the first day of the month, your dental coverage begins on your date of hire.

Note: It may take a few weeks to activate your health benefits. If possible, please wait until you receive your KFHP coverage card to utilize your benefits.

The following applies to Part-Time Associate Physicians:

• Partnership Track - SCPMG pays 100% of the KFHP coverage for Part- Time Associate Physicians and their eligible dependents. Coverage begins for physicians on the date of hire. The enrollment application form must be completed to enroll eligible dependents. Part-Time Associate Physicians also have the option to enroll in Dental and Alternate Mental Health if they pay 50% of the premium.

• Special Category - SCPMG pays 100% of the KFHP coverage and Part-Time Special Category Associate Physicians pay 50% of the premium for Alternate Mental Health and Dental if enrolled. These benefits continue for physicians and their dependents when moved into this category. For



Alternate Mental Health and Dental benefits, if enrolled within 30 days from the date of hire, then benefits are effective as of the hire date.

• Not on Partnership Track - Part-time Associate Physicians and their eligible dependents may enroll in KFHP coverage if they pay 50% of the premium. If enrolled within 30 days from the date of hire, then benefits are effective on hire date. Part-Time Associate Physicians (Not on Partnership Track and not eligible for Partnership) are not eligible for other health care coverage through SCPMG.

Dependent Eligibility

Eligible dependents include:

• your spouse/domestic partner (see Spouse/Domestic Partner Eligibility section) and

• your or your spouse/domestic partner’s dependent children up to the age limit specified for each benefit option

Dependent children must be your or your spouse/domestic partner’s children by birth, legal adoption or legal guardianship. (The legal guardianship must be finalized prior to your dependent reaching age 18.) Your foster children do not qualify for these health care benefits.

Dependent children also include children who are covered under a valid Qualified Medical Child Support Court Order, as defined by ERISA.

Spouse/Domestic Partner Eligibility

A domestic partner is a person living with you in a committed relationship who is not a relative, and with whom you share joint responsibility for each other’s common welfare. Only one person at a time can be enrolled for benefits as your domestic partner. At least 12 months must elapse between the enrollment date of one domestic partner and the enrollment date of a subsequent domestic partner (except in the event of death).

In order for your domestic partner and his/her eligible dependent children to be enrolled in your health care benefits, both you and your domestic partner must complete the appropriate Affidavit. The Affidavit is available from PHR Shared Services. A retired physician working Partner Emeritus and who is enrolled in health care benefits can enroll a domestic partner.

If you are an Associate Physician, health care benefit costs attributed to your domestic partner and/or your domestic partner’s dependents may be taxable to you. If you are an SCPMG Partner Physician or retired Partner Physician, you will have taxable Imputed Income for the full value of all your health care benefits including your domestic partner’s health care benefits.



If your domestic partner relationship ends, continuation coverage equivalent to coverage available to a spouse through COBRA will be offered to your ex-domestic partner. Refer to the Continuation of Health Benefits under COBRA. You must notify PHR Shared Services promptly at 1-877-608-0044 when dissolution of your domestic partnership occurs.

Enrolling/Deleting Eligible Dependents (also referred to as Family Status Changes)

You must notify PHR Shared Services immediately at 1-877-608-0044 of any family status changes that may impact your coverage, such as:

• marriage/domestic partnership

• divorce/dissolution of domestic partnership

• death of spouse/domestic partner

• birth/adoption/placement for adoption/legal guardianship

• when a dependent child is no longer an eligible dependent

• gain/loss of coverage under a Medicaid or Children’s Health Insurance Program (CHIP) program or your dependent gains eligibility for a premium assistance subsidy under a Medicaid or CHIP program.

• gain/loss of coverage through a spouse/domestic partner’s group health plan

• gain/loss of coverage as a result of an address change

Adding dependents to benefits coverage is not automatic. In order to cover eligible dependents who were not enrolled during open enrollment, you must complete the necessary enrollment forms within 30 days of the family status change (60 days in the case of a Medicaid/CHIP event) and provide the following proof of the dependent relationship:

Family Status Change Proof of Dependent Relationship

marriage marriage certificate

add or change domestic partner SCPMG domestic partner affidavit form

divorce/dissolution of domestic partnership

divorce decree/dissolution of domestic partnership

spouse/domestic partner’s death death certificate

birth birth certificate

adoption/legal guardianship court order documents

Medicaid/CHIP events documentation from the applicable state agency or program indicating a gain/loss of coverage under the program or eligibility for a premium assistance subsidy



If you wish to add a new dependent due to birth, adoption or placement for adoption, your dependent will be added retroactive to the date of the family status change if PHR Shared Services is notified and receives the completed enrollment/change forms within 30 days of the family status change event. For Partners Only: If enrollment is received after 30 days, then enrollment is effective the first of the following month.

For all other family status changes, your eligible dependent will be added or removed on the first of the month following your completion of the necessary enrollment/change forms within 30 days of the family status change event (60 days if your family status change is a Medicaid/CHIP event).

Once the appropriate enrollment form is submitted to PHR Shared Services, you have 90 days to send in documents for proof of dependent relationship. If documents are submitted after 90 days from the effective date of coverage, then the dependent’s enrollment will be terminated, generally on a prospective basis. This means that Associate Physicians must wait until the next open enrollment period (generally during the fall of each year, which is effective the next calendar year), unless you have a qualifying family or employment status change, to add their eligible dependents. Partner Physicians may generally add eligible dependents at any time and enrollment is effective the first of the following month.

Dependents of a Deceased Physician

If you are eligible for KFHP coverage and you die leaving a surviving spouse/domestic partner and/or eligible dependents, your spouse/domestic partner and/or eligible dependents will continue to receive the KFHP coverage. Contact PHR Shared Services for more information.

If your surviving spouse remarries, or your surviving domestic partner enters a new domestic partner relationship, he/she will lose his/her eligibility for health coverage under the plan; however, he/she may elect to continue coverage through COBRA or the equivalent continuation coverage available to domestic partners. Refer to the Continuation of Health Benefits under COBRA section for more information.

If your surviving spouse dies or remarries or your surviving domestic partner enters a new domestic partner relationship, any other eligible dependents will retain KFHP coverage until they reach age 26. (There is no age limit for eligible disabled dependent children; however, proof of disability may be required annually. You or your surviving spouse must apply and be approved for the disabled dependent benefit by KFHP prior to the child reaching benefit-limit age. Contact the Kaiser Permanente California Service Center - Disabled Dependent department at 1-858-614-3584 to obtain a Disabled Dependent application). If there is no surviving spouse/domestic partner and your dependents are under age 26, they will be provided with KFHP



coverage until they reach age 26. Dependents who lose KFHP coverage and/or other coverage eligibility may be able to continue coverage through COBRA. Refer to the Continuation of Health Benefits under COBRA section for more information.

If you are a Partner Physician, your surviving dependents will be required to pay income tax on the value of the health and welfare benefit coverage.

Cost

Except as otherwise provided below, SCPMG pays the full cost of coverage for you and your eligible dependents for the benefit coverages noted with an asterisk *, Part-Time Associate Physicians not on Partnership Track are not eligible for these benefits.

• KFHP

– Part-Time Associate Physicians not on Partnership Track – pay 50% of the monthly premium if enrolled

• Supplemental Medical*

• Comprehensive Medical* (only available for Partner Physician on approved extended education leave, medical service leave, medical leave and retirees)

• Alternate Mental Health*

– Part-Time Associate Physicians on Partnership Track pay 50% of the monthly premium if enrolled.

• Dental Care*

– Part-Time Associate Physicians on Partnership Track pay 50% of the monthly premium if enrolled

• Employee Assistance Program

Eligible physicians may elect to purchase Special Dependent coverage for certain other individuals who do not qualify as your eligible dependents under another medical benefits option. Note: Special Dependent coverage is not available for Part-Time Associates.

The cost and payment for your health care benefits may be affected by leave-related and other events, such as your participation in a form of time-off benefits or continuation in your coverage via COBRA. In all instances, contact PHR Shared Services for additional information at 1-877-608-0044.



Imputed IncomeImputed Income is taxable income you earn but receive as something of value rather than as cash compensation. For certain benefits you receive, the law requires that you be taxed on this income. Examples are provided below and may change from time-to-time.

Partner PhysiciansThe value of health care benefits provided to you and your eligible dependents is considered Imputed Income and appears as taxable income on your annual SCPMG Schedule K-1, as applicable.

Associate PhysiciansThe value of the health care benefits for your domestic partner is considered Imputed Income and appears as taxable income on your annual Form W-2, as applicable. Under certain circumstances, tax laws may require that certain other benefits you receive be included in your taxable income.

Example 1: Partner Physician—Imputed IncomeA Partner Physician with a spouse and two dependent children participates in all available SCPMG benefits options, including coverage for KFHP, Supplemental Medical, Alternate Mental Health and Dental through Delta Dental PPO. The value of the family coverage provided to the Partner Physician will be included as taxable income in the Partner Physician’s annual SCPMG Schedule K-1.

Example 2: Associate Physician—Imputed IncomeAn Associate Physician with one dependent child and a domestic partner participates in all available SCPMG benefit options, including coverage for KFHP, Supplemental Medical, Alternate Mental Health and Dental through Delta Dental PPO. The Associate Physician is the biological parent of the one dependent child. The value of the coverage attributable to the domestic partner will be included as taxable income in the Associate Physician’s annual Form W-2.

Termination of Coverage

Your active health care coverage, including KFHP, will cease at the end of the month upon termination of employment, retirement, withdrawal from the Partnership or when you elect to waive coverage.

Termination of Dependent Coverage

Dependents will be terminated from coverage as follows:

• your spouse (in the event of divorce) at the end of the month in which PHR Shared Services receives an Enrollment Application or Change Form (if your marriage ends, you must submit the divorce decree to PHR within 90 days).

• your domestic partner (in the event of dissolution) at the end of the month in which PHR Shared Services receives an Enrollment Application or Change Form (if your domestic partnership ends, you must notify PHR within 90 days).

• your or your spouse/domestic partner’s children—at the end of the month:

– in which their 26th birthday occurs (unless approved by KFHP for disabled dependent benefit; contact the Kaiser Permanente California Service Center - Disabled Dependent department at 1-858-614-3584 to obtain a Disabled Dependent application), or when they are otherwise no longer an eligible dependent



Coordination of Benefits Coverage

If a covered person has other medical coverage not provided by SCPMG, the claims administrator will coordinate the benefits payable under the SCPMG plan with those of the other plan. One plan is primary and the other is secondary. The primary plan pays regular benefits in full. The secondary plan pays a reduced amount, which when added to the benefits paid by the primary plan, will not exceed 100% of allowable expenses.

The coordination of benefits rules described in this Handbook provide a general overview of these rules and are subject to change. If you have any questions about coordination of benefits, please contact KFHP Member Services at 1-800-464-4000 or Meritain Health at 1-888-711-7876.

A plan that does not coordinate with other plans is always the primary plan. If both plans coordinate, the primary plan is generally determined as follows:

• The plan that covers the patient as Partner or Associate Physician rather than as a dependent is primary. The plan covering the patient as a dependent is the secondary plan.

• If a dependent child is covered under both parents’ plans, the plan covering the parent whose birthday falls earlier in the calendar year is generally the primary plan. If both parents share the same birthdays, the plan covering the parent longer is generally the primary plan.

• If a dependent child is covered under both parents’ plans but the parents are separated or divorced, the primary plan will be determined in this order:

– the plan of the parent awarded financial responsibility by a court decree for the child’s health care expenses,

– the plan of the parent with custody of the child

– the plan of the stepparent married to the parent with custody of the child

– the plan of the parent not having custody of the child.

If none of the above rules apply, then the plan covering the patient the longest is generally the primary plan (except that a plan covering a retiree will be secondary).

Dual Coverage

Dual coverage is defined as having coverage when you are covered under KFHP coverage as both a subscriber and as a dependent of another KFHP subscriber. While you are continuing to work in a benefit-eligible category, being covered under two plans is allowable. Once you become covered under Senior Advantage (at age 65) or another Medicare-assigned program and are eligible for Medicare Part A and B, you are not allowed to be covered under KFHP with dual coverage. You will need to select one coverage option to be maintained, and you will need to drop the other. Being covered under two Medicare-assigned programs, such as Senior Advantage, is not permitted.



KAISER FOUNDATION HEALTH PLAN (KFHP)


Partners and Part-Time Associate Physicians on Partnership Track are automatically enrolled in KFHP coverage. Part-Time Associate Physicians not on Partnership Track must affirmatively elect to enroll. Dependent enrollment is not automatic. Eligible dependents must be enrolled to receive benefits. Eligibility requirements are described in the Eligibility and Enrollment section above and the Eligible Dependents section below.

Eligible Dependents

Dependents eligible for KFHP coverage include:

• your spouse/domestic partner

• your or your spouse/domestic partner’s dependent children up to age 26

• your or your spouse’s/domestic partner’s dependent children over age 26 who were disabled before age 26 and are incapable of self-support due to a mental or physical handicap. Proof of disability may be required annually. You must apply and be approved for disabled dependent benefit prior to your dependent child reaching benefit-limited age. Contact the Kaiser Permanente California Service Center - Disabled Dependent department at 1-858-614-3584, to obtain a Disabled Dependent application

• children whose parent is a dependent under your family coverage (including adopted children or children placed with your dependent for adoption; but not including foster children) if they meet the following requirements: (i) They are under age 26; (ii) They are not married and do not have a legally recognized spouse/domestic partner; (iii) They receive all of their support and maintenance from you or your spouse/domestic partner; and (iv) They permanently reside with you or your spouse/domestic partner.


If you die while practicing with SCPMG, your spouse/domestic partner and eligible dependents will be provided KFHP coverage at SCPMG expense. This benefit is not dependent on your age or years of service at the time of your death.

If your surviving spouse remarries, or your surviving domestic partner enters into a new domestic partner relationship, the surviving spouse/domestic partner’s eligibility for KFHP coverage will end. A surviving spouse or domestic partner may be able to continue coverage through COBRA or the equivalent continuation coverage available to domestic partners. Refer to the Limited Continuation of Benefits Available (COBRA) below. Conversion to an individual plan may be available.



If your surviving spouse dies or remarries, or your surviving domestic partner dies or enters a new domestic partner relationship, any other eligible dependents will retain KFHP coverage until they reach age 26. There is no age limit for eligible disabled dependent children (however, proof of disability may be required annually).

If there is no surviving spouse/domestic partner but your dependents are under age 26, they will be provided with KFHP coverage until they reach age 26. There is no age limit for coverage for disabled dependent children (as described under Eligible Dependents in the beginning of this section).

Disabled Physicians

If you are determined as Disabled under Common Plan Part II, you, your spouse/domestic partner, and any eligible dependents will retain KFHP coverage as if you were an eligible retiree. Generally, if you leave SCPMG due to disability with at least five years of Common Plan Qualifying Service, but not enough service for retiree benefits, you will have health coverage continued for yourself and eligible dependents at SCPMG’s expense. Supplemental Medical coverage will cease.

Refer to the Common Plan Summary Plan Explanation for details on Disability Retirement, or contact PHR Shared Services for additional information at 1-877-608-0044.

Coverage Highlights

KFHP coverage benefits are described in detail in the annual Evidence of Coverage (EOC) brochure that is available from your regional PHR Shared Services or local Permanente Human Resources department and incorporated by reference in this Handbook. The benefits may be subject to change annually due to contract revisions.

Listed below are highlights of some of the benefits available to you and your covered dependents under KFHP coverage. In the event of any conflict between this Handbook and the EOC, the EOC will control so be sure to refer to the EOC for complete details.



Covered Services Your Cost

In the Medical Office

Doctor office visits, including physicals No charge

Well-child care, vision and hearing exams No charge

Lab, X-rays, and other tests No charge

Physical, occupational, and speech therapy No charge

Behavioral health treatment for autism spectrum disorders No charge

In the Hospital

Hospital room and board, intensive care No charge

Physician and surgeon services, general nursing services No charge

Blood components and blood transfusions No charge

Drugs, medicines, dressings, and casts No charge

Lab, X-rays and other tests No charge

Maternity Care

Office visits, lab and other tests, hospitalization, and full care of newborn while the mother is in hospital

No charge

Prescriptions

Up to a 100-day supply filled in any Health Plan pharmacy; prescriptions must fall within Kaiser Permanente’s formulary guidelines

For formulary information, contact Kaiser Permanente Member Services at 1-800-464-4000 or kp.org; click the “Health Plans & Services” tab, then click on “Using Our Services”

$5 per prescription

Mental Health Care

Unlimited inpatient and outpatient visits per calendar year No charge

Care for Alcoholism and Chemical Dependency

In the medical office—counseling for dependency and medical management of withdrawal symptoms

No charge

(continued)



Covered Services Your Cost

In the hospital—when necessary for medical management of withdrawal symptoms, recovery services for dependency including education and counseling

No charge

Vision Care

Vision exams No charge

Optical $175 allowance every 24 months

Hearing Care

Hearing tests and hearing aids—for more information, contact HEARx at 1-877-714-2828 or visit hearusa.com

$2,500 allowance per device, per member, every 3 years. 20% discount on hearing aid purchases

Emergency Services in Southern California Service Area

In a Health Plan facility You pay only the copayments that normally apply to the services you receive

In a Non-Health Plan facility If determined to be an emergency by the KFHP Claims Department, you pay any copayments that normally would apply had you received the services from a Health Plan Provider

Declining Coverage

If you are automatically enrolled in KFHP, its coverage may be declined only in two situations. You may decline coverage if you are covered as a dependent by your spouse/domestic partner who is a Kaiser employee or physician with Kaiser Permanente and who has enrolled for health benefits. Or, you may decline coverage if you are covered under a health plan of a previous employer through COBRA continuation coverage if it would be detrimental to you to give up the COBRA benefits.

If you decline KFHP coverage, then all other health care benefits are also declined, including coverage for Supplemental Medical, Alternate Mental Health and Dental.


If you terminate service with SCPMG, KFHP coverage will terminate for you and your eligible dependents at the end of the month in which your service ends.

Dependents will be terminated from coverage as follows:

• spouse (in the event of divorce)—at the end of the month in which PHR Shared Services receives the Enrollment Application or Change Form, provided the divorce decree is submitted within 90 days



• domestic partner (in the event of dissolution)—at the end of the month in which PHR Shared Services receives the Enrollment Application or Change Form, provided the dissolution of domestic partnership is submitted within 90 days

• children—at the end of the month:

– in which their 26th birthday occurs

– when they are no longer an eligible dependent

In the event that PHR Shared Services does not receive proof of dependent coverage within 90 days from the effective date of coverage.

If at any time a physician’s or dependent’s coverage ends, you may have a choice to continue your coverage under COBRA or to convert your KFHP coverage to an individual policy.

Conversion of Coverage

If you or your eligible dependents lose KFHP coverage, you may be given an opportunity to convert your KFHP coverage to an individual policy through KFHP without a medical review.

For more information about conversion rights, please contact Kaiser Permanente Member Services at 1-800-464-4000.

Limited Continuation of Benefits Available (COBRA)

If you and/or your dependents lose KFHP coverage benefits due to termination of employment, reduction of scheduled hours, disability, death, divorce, or children reaching the limiting age, KFHP coverage benefits may be purchased through COBRA for a maximum of 18, 29 or 36 months, depending on the reason for the termination of coverage. The coverage you purchase will generally be identical to the coverage you had. Premium rates are available from PHR Shared Services. Cal-COBRA may also be available to you after COBRA ends. Refer to the Continuation of Health Benefits under COBRA section of this Handbook for a general discussion of COBRA. A domestic partner who loses coverage due to one of the events listed above or as a result of dissolution of the domestic partnership will be offered continuation coverage that is equivalent to the coverage provided through COBRA. Refer to the Continuation of Health Benefits under COBRA section of this Handbook for more information.

KAISER FOUNDATION HEALTH PLAN (KFHP) SPECIAL DEPENDENT COVERAGE

(Under Kaiser Foundation Health Plan)


Eligible active and retired physicians in all categories (except part-time and Per Diem Physicians) can enroll special dependents in KFHP coverage at their own expense, called Special Dependent coverage.



Special Dependents are limited to:

• your parents

• the parents of your spouse/domestic partner

• your step-parents or the step-parents of your spouse/domestic partner

• coverage is restricted to one set of parents for the eligible physician and one set of parents for the spouse/domestic partner

• your over-age children and their eligible dependents

Physicians eligible to enroll their Special Dependents include:

• Associate Physicians (working an 8/10 schedule or more)

• Partner Physicians

• retirees eligible for post-retirement health benefits

Special Dependents Over Age 65

Any Special Dependent who is over age 65 and eligible for Medicare must enroll in Senior Advantage. (Refer to the Glossary for a description of Senior Advantage.) KFHP will notify your Special Dependent(s) approximately 90 days before enrollment in Senior Advantage.

KFHP sends out the Senior Advantage enrollment to the Special Dependent approximately 90 days before reaching age 65. Neither KFHP nor SCPMG send notification to the SCPMG physician.

Senior Advantage provides all of the benefits provided by Medicare as well as certain additional benefits. When first enrolled in Senior Advantage, your Special Dependent will have KFHP coverage and be charged the standard KFHP coverage rate. Once the Centers for Medicare & Medical Services (CMS) notifies KFHP that your Special Dependent is an eligible Medicare member, he/she will be transferred to the Senior Advantage premium.

Surcharges are applied to the KFHP coverage premium, if your Special Dependent:

• is neither eligible nor enrolled for either Part A or B of Medicare, or

• has Medicare but has not assigned it to KFHP, or

• has assigned his/her Medicare to another risk provider

Your Special Dependent is not entitled to Medicare reimbursement for the KFHP coverage premium.

Dependents of a Retired or Deceased Physician

Special Dependents may retain their KFHP coverage upon your retirement or death as long as you meet eligibility requirements for retirement at the time of retirement or death. If you were paying the premiums through payroll deduction, payment of premiums will be directly billed to your Special Dependent.



How Special Dependent Coverage Works

Special Dependents are eligible for KFHP coverage at your or your Special Dependent’s expense provided they permanently reside in the California service area, and:

• they are not hospital-confined at the time of enrollment, or

• they do not have end-stage renal disease

Premiums may be paid either by payroll deduction or direct billing to your Special Dependents.

You may obtain an enrollment application for Special Dependent coverage at your local Permanente Human Resources office, on the SCPMG Physician Portal at scpmgphysician.kp.org or by calling PHR Shared Services 1-877-608-0044. The Special Dependent and the physician will be required to complete the necessary Special Dependent Enrollment Forms.

Special Dependent status is not available on a temporary or short-term basis (such as for vacation leaves).

Only KFHP coverage is available to Special Dependents; the other health care benefits including Supplemental Medical, Alternate Mental Health and Dental are not available to Special Dependents.


If you do not meet the eligibility requirements for retirement when you leave SCPMG, your Special Dependents will be removed from KFHP coverage, and they may have the opportunity to convert to a Conversion Policy. Conversion Policy is not described in this Handbook. Contact Kaiser Permanente Member Services at 1-800-464-4000 for individual policy information.

Loss of KFHP Coverage Following Divorce or Dissolution of Domestic Partnership

In the event of divorce or dissolution of a domestic partnership, your former spouse/domestic partner is not eligible for Special Dependent status. Instead, your former spouse/domestic partner may be able to continue KFHP coverage through the COBRA program or the equivalent continuation coverage available to domestic partners. Refer to the Continuation of Health Benefits under COBRA section for a general discussion of COBRA. Conversion to a Conversion Policy may also be available. Conversion Policy is not described in this Handbook. For more information about Conversion Policy and conversion rights, contact Kaiser Permanente Member Services at 1-800-464-4000.

Note: If you transfer to Part-Time Associate or Per Diem Physician status, you may not add any new Special Dependents, and your current Special Dependents’ benefit enrollment will terminate. However, Retirees receiving Retiree Medical benefits may continue their Special Dependents and add new Special Dependents.



Special Dependents May Not Elect Limited Continuation of Benefits (COBRA)

Continuation coverage through COBRA is not available for Special Dependents who lose their eligibility to participate in Special Dependent coverage.

SUPPLEMENTAL MEDICAL COVERAGE

SCPMG’s Supplemental Medical coverage is intended to cover certain medical services that are either excluded from KFHP coverage or exceed KFHP coverage limits. Supplemental Medical coverage is not an alternative to using your KFHP coverage. If you or your eligible dependents elect to use facilities or services other than those offered or available from KFHP, any expense you incur will be excluded under Supplemental Medical coverage.

Supplemental Medical coverage may not be used for routine care outside of a KFHP service area.


If you are eligible for Supplemental Medical coverage, you will automatically be enrolled in Supplemental Medical. Dependent enrollment is not automatic. You must enroll eligible dependents in order for them to receive benefits; however, if you have enrolled your eligible dependents in KFHP coverage, they will automatically be enrolled in Supplemental Medical coverage. Eligibility requirements are described under Eligibility and Enrollment in the KFHP section and Eligible Dependents section below.

Eligible Dependents

Dependents eligible for Supplemental Medical include:


• your or your spouse’s/domestic partner’s dependent children up to age 26

• your dependent children over age 26 who were disabled before age 26 and are incapable of self-support due to a mental or physical handicap. Proof of disability may be required annually. You must apply and be approved for disabled dependent benefit by KFHP prior to your dependent child reaching benefit limited age. Contact the Kaiser Permanente California Service Center - Disabled Dependent department at 1-858-614-3584, to obtain a Disabled Dependent application

• children whose parent is a dependent under your family coverage (including adopted children or children placed with your dependent for adoption; but not including foster children) if they meet the following requirements: (i) They are under age 26; (ii) They are not married and do not have a legally recognized spouse/domestic partner; (iii) They receive



all of their support and maintenance from you or your spouse/domestic partner; (iv) They permanently reside with you or your spouse/domestic partner


If you die after having met the age and service requirements for early retirement, refer to the Leaving SCPMG section of this Handbook or the Retiree Benefits Handbook for the eligibility requirements for early retirement. Supplemental Medical coverage will be continued for your surviving spouse/domestic partner until death or remarriage or until he/she enters into a subsequent domestic partnership. It will also continue for any eligible dependent children until they reach age 26. There is no age limit for coverage for disabled dependent children (as described under Eligible Dependents in the beginning of this section).

How Benefits Work

• To qualify for Supplemental Medical coverage, you must first pay an individual and/or family deductible each year. (Additional details are provided under Deductibles and Maximum Benefits for Partner Physicians and Deductibles and Maximum Benefits for Associate Physicians at the end of this section.)

• After you have met the calendar-year deductible requirement, Supplemental Medical coverage will pay benefits equal to 100%, 80% or 50% of the reasonable and customary (R&C) cost of covered charges.

• Supplemental Medical coverage provides benefits up to specific maximum levels based on your category. (Additional details are provided under Deductibles and Maximum Benefits for Partner Physicians and Deductibles and Maximum Benefits for Associate Physicians at the end of this section.)

• If you receive treatment or services from a provider who is not in the Kaiser network, you must submit a claim form and the itemized bill to receive reimbursement for covered services, unless the provider is in the Aetna Choice Plus PPO network (in which case the provider would submit a claim to Meritain Health, SCPMG’s claim administrator).

• If you receive treatment or services from an Aetna contracted provider, your costs may be less. To find a network provider, visit meritain.com to create a Meritain Health account. Once you create an account, click on “Find a Doctor or Hospital in Your Network,” then follow the instructions to search for a provider. When choosing a network provider online, select Aetna Choice POS II.



Covered Charges

Supplemental Medical coverage only pays for a portion of the charges for medical care that is either excluded from KFHP coverage or exceeds KFHP coverage limits. KFHP coverage provides benefits for such services as hospitalization, physician fees and prescription drugs. Refer to the Evidence of Coverage brochure and the Kaiser Foundation Health Plan (KFHP coverage) section of this Handbook for more information. As a result, these items are not covered charges under Supplemental Medical coverage.

In some cases, you may be required to provide a “denial” letter from KFHP indicating that a given service is not covered or that you have surpassed the coverage maximum. Refer to the Filing Supplemental Medical Coverage Claims in this section.

Covered charges under Supplemental Medical coverage are paid at 100%, 80% or 50% of the R&C cost for the area in which you receive services.

If you have any questions about a covered charge, please call Meritain Health at 1-888-711-7876. Refer to the Claims, Appeals and Administrative Information for additional contact information.

Charges covered at 100% of the reasonable and customary cost include:

• hospice care (hospice room and board, ill-patient physician visits, and hospice home care). A denial letter from KFHP is required. Hospice home care includes:

– charges by a hospital or home health agency for up to 100 visits;

– charges by a licensed social worker, up to a maximum of $50 per visit, for not more than one visit in any week;

– professional services for rendering emotional support to the terminally-ill patient up to a maximum of $50 per visit;

– professional services for family counseling after the death of the terminally-ill patient, up to a maximum for all covered family members combined of $50 per visit for not more than six visits in the 12-month period after the death of the terminally-ill patient;

– charges incurred for special services, such as transportation between the hospice and the patient’s home and special dietary services, up to a maximum of $25 per day and up to a lifetime maximum of $100.

– Any charge that is not payable under hospice care, but would be payable under another section of this Supplemental Medical coverage, will be payable as stated in that section.

Charges covered at 80% of the reasonable and customary cost include:

• acupuncture services performed by a licensed acupuncturist for medically necessary treatment

• blood, blood products, blood transfusions, and their administration only if they are not available through KFHP coverage



• convalescent care in a skilled nursing facility or a hospital. Covered charges include rehabilitation benefits such as physical, occupational, speech, respiratory, or radiation therapy. A denial letter from KFHP is required. Care must be provided by skilled personnel such as RNs or LVNs. Coverage for care in an intermediate facility is provided in most cases

• chiropractic care performed by a licensed chiropractor for the medically necessary treatment of an illness or injury

• outpatient durable medical equipment, such as wheelchairs, braces, and hospital beds. A denial letter from KFHP is required

• alcohol and chemical dependency rehabilitation treatment programs on an inpatient basis and outpatient individual and/or group therapy. A denial letter from KFHP is required

• mental health services on an inpatient basis and outpatient individual and/or group therapy

– you must receive a diagnosis of psycho-pathological disorder and a Kaiser treatment plan

– if a treatment plan is not available within Kaiser, you must obtain a denial letter from KFHP, in addition to a provider letter stating a diagnosis of psycho-pathological disorder in order to receive covered treatment outside of Kaiser

• infertility services, including services for artificially-induced contraception, in vitro fertilization, ovum transplant, gamete and zygote intrafallopian transfer, genetic testing related to infertility treatments, the cost of medical services in procuring donor semen and donor eggs (but not the financial compensation paid for the purchase of donor eggs or sperm), and treatment to reverse voluntary surgically-induced fertility. A denial letter from KFHP and documentation of a diagnosis of infertility are required. Storage or freezing of eggs is not covered

Important Information Regarding Infertility Treatment and Cash Agreements with Providers

When seeking infertility treatment, please provide your Meritain Health information at the first appointment. Your provider may have alternative billing arrangements or “cash agreements” available. Please be aware that when you accept a cash agreement for services, you are waiving the right to have your provider bill Meritain Health (if your provider is a preferred or in-network provider), provide documentation to the patient or Meritain Health that is needed in order to allow Meritain Health to process claims, and cooperate with Meritain Health to facilitate claims payments. This will preclude Meritain Health from paying a benefit.

Note: If you go to an in-network provider, that provider has a contractual agreement to bill Meritain Health.

• jaw joint disorder treatments (such as TMJ). A denial letter from KFHP and documentation of a diagnosis of infertility are required



• dental work required as the result of—and begun within one year of—an accident. A denial letter from KFHP is required

• podiatry services for medically necessary foot care that are not covered by KFHP coverage

• cosmetic surgery required due to an accident while insured under this program. (This also applies to children born with a congenital abnormality while insured by this plan)

• prescription drugs prescribed in connection with services not normally provided by KFHP coverage

Charges covered at 50% of the reasonable and customary cost of services include, but are not limited to:

• custodial care, either at home or at a skilled nursing facility, with evidence of total and permanent disability

Important Definition

Custodial care is defined as care primarily required to meet the needs of the activities of daily living (ADLs), such as walking, dressing, and caring for personal hygiene. The individual must be diagnosed as totally and permanently disabled in order to use the custodial care benefit. The care can be provided either at home or at an eligible facility. If provided at home, care must be provided by state licensed home health aides. Examples of these individuals include home caregivers, certified nursing assistants, or residential assistants. (In-home skilled nursing care is covered under KFHP.) Care provided by family members or other informal caregivers is not covered.

• An eligible facility may be a licensed nursing home, a licensed skilled nursing facility, or a hospital

• Adult day care centers are not considered eligible facilities

• Managed care consulting is provided if deemed necessary by a continuing care nurse who contracts with Meritain Health Health for managed care services

Exclusions

The following services and supplies are not covered by Supplemental Medical coverage; however, they may be covered under another benefit option such as KFHP coverage. This list is a non-exhaustive summary of the exclusions and may change from time to time. If you have questions about a specific service or supply, call Meritain Health, the claims administrator. Refer to the Claims, Appeals and Administrative Information section for contact information.

• abortion

• allergy testing and treatment

• ambulance service

• anesthesia

• blood, blood products, blood transfusions and their administration if offered by KFHP

• chelation therapy

• chemotherapy



• contact lenses

• corrective eye surgery

• cosmetic services

• dermatology

• dialysis and organ transplants (inpatient and outpatient)

• dressings, casts, and inpatient durable medical equipment

• education, training, instruction or educational therapy

• electronic voice producing machines

• emergency room visits

• excess prescriptions (charges for any prescription filled in excess of the number specified by a physician, or any refill dispensed after one year from the date of the physician’s original order)

• experimental or investigational charges

• eye examinations for eyeglasses, unless due to a cataract operation or diabetic retinopathy

• eyeglass frames and lenses, unless due to a cataract operation or diabetic retinopathy

• general health services not addressed to a specific condition

• health education publications

• hearing tests and hearing aids

• hospital care, including room and board, and a private room

• immunizations in general use

• immunosuppressive drugs

• injury or illness caused by war or an act of war

• injectable contraceptives

• intensive care

• internally-implanted, time-released drugs (including contraceptives)

• KFHP co-pays or coinsurance

• laboratory tests, X-ray services, and other diagnostic tests, including electrocardiograms, mammograms, and Pap smears

• luxury services and no-charge services

• obesity treatment

• obstetrical services

• on-the-job accidents or illnesses covered by Workers’ Compensation or similar laws

• operating and recovery room



• physician and surgical services

• physician home visits and routine office visits

• prenatal care

• prescribed drugs, supplies and supplements

• prescription drugs obtained at Kaiser Permanente pharmacies, including copayment limit

• preventive care, including routine physical exams and gynecological visits

• prosthetic and orthotic devices and braces

• radiation therapy and radioactive materials used for therapeutic purposes

• reconstructive surgery

• respiratory therapy

• routine care inside or outside a KFHP service area

• treatment for medical conditions resulting from participation in felonious activity

• treatment at a Veteran’s Administration Hospital or by a VA physician

• ultraviolet light treatment

• visiting nurse home visits

• well baby care

Filing Supplemental Medical Coverage Claims

Claims are only required if you receive treatment or services from an out-of-network provider (an in-network provider will submit a claim for you). Submit out-of-network claims directly to Meritain Health, the claims administrator. Payments of approved claims are sent to your home or to your provider.

Claims and necessary documents must be submitted within one year of the date treatment or services are provided (even if you have left SCPMG) in order to qualify as a covered expense. For more information, refer to the Claims, Appeals and Administrative Information section of this Handbook.

If a denial letter from KFHP is required, you must obtain one by calling Member Services at 1-800-464-4000. Be sure to attach a copy of the denial letter to your claim form. Contact information for Meritain Health may be found in the Claims, Appeals and Administrative Information section.

Claim forms may be obtained from PHR Shared Services at 1-877-608-0044 or the SCPMG Physician Portal at scpmgphysician.kp.org.

Deductibles and Maximum Benefits for Partner Physicians

This section provides additional details about Supplemental Medical coverage that are specific to Partner Physicians.



Annual Deductibles

To qualify for Supplemental Medical benefits, you must first pay an annual deductible:

• Individual deductible: $50 per person per calendar year.

• Family deductible: $100 per family per calendar year.

When two or more individuals in a family incur covered charges that are used to satisfy their individual deductible amounts in the same calendar year and the total is at least $100, then no further deductible amounts are required for the rest of the year for that family for all covered expenses.

After you have met the calendar-year deductible requirement, Supplemental Medical coverage will pay benefits as described earlier in this section.

Calendar Year and Lifetime Maximums

For Partner Physicians, there are no calendar-year or lifetime limits on covered services and/or supplies.

Deductibles and Maximum Benefits for Associate Physicians

This section provides additional details about Supplemental Medical coverage that are specific to eligible Associate Physicians (who work an 8/10 schedule or more).

Annual Deductibles

To qualify for Supplemental Medical benefits, you must first pay an annual deductible:

• Individual deductible: $100 per person per calendar year

• Family deductible: $200 per family per calendar year

When two or more individuals in a family incur covered charges that are used to satisfy their individual deductible amounts in the same calendar year and the total is at least $200, then no further deductible amounts are required for the rest of the year for that family for all covered expenses.

After you have met the calendar-year deductible requirement, Supplemental Medical coverage will pay benefits as described earlier in this section.

Calendar Year and Lifetime Maximum

For eligible Associate Physicians, the following services and/or supplies are limited by a calendar-year or lifetime maximum benefit amount.

Calendar Year Maximums

• chiropractic care is limited to $1,000 per person



Lifetime Maximum Benefits

• infertility treatments are limited to $30,000 per covered person

• jaw joint disorder treatments (such as TMJ) are limited to $2,000 per covered person

Other Information

Supplemental Medical coverage for Associate Physicians are subject to federally required discrimination testing. Because of this requirement, certain Supplemental Medical benefits provided to Partner Physicians may not be available to Associate Physicians.

Declining Coverage

If KFHP coverage is declined, then Supplemental Medical coverage is also declined. Refer to the Declining Coverage in the Kaiser Foundation Health Plan (KFHP) section for more details.


If you terminate service with SCPMG, Supplemental Medical coverage will terminate for you and your eligible dependents at the end of the month in which your service ends.

In addition, dependents will be terminated from coverage as follows:



• children—at the end of the month in which their 26th birthday occurs

No Conversion

Conversion to an individual policy is not available under this coverage.


If you and/or your dependents lose Supplemental Medical coverage due to termination of employment, reduction of scheduled hours, disability, death, divorce or children reaching the limiting age, Supplemental Medical coverage may be purchased through COBRA for a maximum of 18, 29 or 36 months, depending on the reason for the termination of coverage. The coverage you purchase will generally be identical to the coverage you had. In order to be eligible for Supplemental Medical coverage through COBRA, you must also be enrolled in KFHP coverage. Premium rates are



available from PHR Shared Services. Refer to the Continuation of Health Benefits under COBRA section of this Handbook for a general discussion of COBRA. A domestic partner who loses coverage due to one of the events listed above or as a result of dissolution of the domestic partnership will be offered continuation coverage that is equivalent to the coverage provided through COBRA. Refer to the Continuation of Health Benefits under COBRA section of this Handbook for more information.

COMPREHENSIVE MEDICAL PLAN

Comprehensive Medical coverage is an alternative to KFHP coverage for:

• eligible Partner Physicians on extended educational/medical service/military leave outside of a Kaiser Permanente service area, and

• eligible retirees.

Refer to the Leaving SCPMG section in this Handbook for more information.


Comprehensive Medical coverage is available to eligible retirees and Partner Physicians on extended educational/medical/military service leave outside of a Kaiser Permanente service area. It is intended for those eligible physicians who cannot avail themselves of—or choose not to use—KFHP coverage. It is not a substitute for KFHP coverage for active physicians. If you are eligible for health care benefits in retirement, you may elect Comprehensive Medical coverage in place of KFHP coverage or Senior Advantage if living outside the Kaiser Permanente service area.

With 30 days’ notice, you may change to Comprehensive Medical coverage upon moving out of a Kaiser Permanente service area. You must re-enroll in KFHP coverage if you resume living in a Kaiser Permanente service area.

How the Plan Works

The Comprehensive Medical Plan allows you to visit any doctor or facility to receive services.

After you meet an annual deductible, you share the cost of covered services by paying a coinsurance, which is a percentage of the contracted rate or reasonable and customary (R&C) charges for the service received. However, you should be prepared to pay the full amount at the time of service, since you will need to file a claim to receive reimbursement from Meritain Health, SCPMG’s third-party administrator.

If you see an Aetna contracted provider, your costs may be less. To find a network provider, visit meritain.com to create a myMeritain Health account. Once you create an account, click on “Find a Doctor or Hospital in Your



Network,” then follow the instructions to search for a provider. When choosing a network provider online, selection Aetna Choice POS II.

When Meritain Health receives your claim, they will authorize payment of the percentage of the contracted rate or R&C charges, which they determine by reviewing the cost of similar claims in your geographical area. You will be responsible for paying the remaining percentage and for the full amount of any costs in excess of the R&C charges.

Filing Comprehensive Medical Coverage Claims

Claims are only required if you receive treatment or services from an out-of-network provider (an in-network provider will submit a claim for you). Submit out-of-network claims directly to Meritain Health, the claims administrator. Payments of approved claims are sent to your home or to your provider.

Claims and necessary documents must be submitted within one year of the date treatment or services are provided (even if you have left SCPMG) in order to qualify as a covered expense.

Claim forms may be obtained from PHR Shared Services at 1-877-608-0044 or the SCPMG Physician Portal at scpmgphysician.kp.org.

Annual Deductible

For each calendar year, the deductible is $300 per person or $600 per family.

Annual Out-of-Pocket Maximum

For each calendar year, the out-of-pocket maximums are $5,000 per person, and $10,000 per family. Once the out-of-pocket maximum is met, Comprehensive Medical coverage will cover 100% of R&C charges for all charges normally covered at 80%.

Charges covered at 50% will not be counted toward the out-of-pocket maximum, and you will still be required to pay 50% coinsurance for these charges after reaching the annual out-of-pocket maximum.

Any deductibles you pay are not counted toward out-of-pocket maximums.

Individual Benefit Maximum

The maximum lifetime individual benefit is $1,000,000 under Comprehensive Medical coverage.

Covered Services

Covered services are paid at either 50% or 80% after the annual deductible has been met. The following is a list of many of the services covered under Comprehensive Medical Plan. This list may change from time to time. You may contact Meritain Health at 1-888-711-7876 if you have a question about a service not listed.



Charges covered at 50% include (coinsurance payouts are not counted toward annual out-of-pocket maximum): custodian care (home health services or skilled nursing facility)

Charges covered at 80% include:

• acupuncture

• adult physical exams, limited to one per year

• alcohol and chemical dependency rehabilitation programs on an inpatient basis and outpatient individual and/or group therapy

• allergy testing and treatment

• ambulance

• ambulatory service center

• anesthesia

• blood, blood products, blood transfusions, and their administration

• chelation therapy

• chemotherapy

• chiropractic, limited to $1,000 per year

• dental services for accidental injuries only; services must be received within 12 months of the accident

• dermatology

• diagnosis and treatment of illness or injury

• dialysis

• dressings and casts

• durable medical equipment

• emergency services

• family planning counseling

• hearing tests

• home visits by physician or visiting nurse

• hospital admissions kit

• hospital alternative treatment services

• hospital services, inpatient or outpatient

• immunizations in general use

• immunosuppressive drugs

• infertility services, limited to a lifetime maximum of $30,000

• inpatient mental health services and outpatient individual and/or group therapy

• inpatient-prescribed drugs and medical supplies

• inpatient rehabilitation



• intensive care

• jaw joint disorder, limited to a lifetime maximum of $2,000

• lab and X-ray services, including electrocardiograms, mammograms and Pap smears (preventive Pap smears and mammograms are limited to one per year)

• maternity care, inpatient and outpatient

• obstetrical and gynecological services

• operating room and recovery

• preventive care, limited to annual physical exam and gynecological visits

• prosthetic devices and braces

• psychological testing

• radiation therapy and radioactive materials used for therapeutic purposes

• reconstructive breast surgery (all stages) as a result of a mastectomy on one or both breasts, as determined by the attending physician to be appropriate, to restore and achieve symmetry between the two breasts

• reconstructive surgery, non-cosmetic

• respiratory therapy

• skilled nursing facility (services covered at 50% if care is custodial)

• sterilization

• substance abuse, inpatient

• therapy—biofeedback, occupational, physical, physio, rehabilitation and speech— inpatient and outpatient, only if prescribed by a physician

• transplants

• ultraviolet light treatment

• well baby/well child care; year one exams are limited to six routine visits; year two exams are limited to three routine visits; after age two exams are limited to one per year

Charges covered at 100% include:

• Hospice Services (hospice room and board, ill-patient physician visits, and hospice home care). Hospice home care includes:

– charges by a hospital or home health agency for up to 100 visits

– charges by a licensed social worker, up to a maximum of $50 per visit, for not more than one visit in any week

– professional services for rendering emotional support to the terminally-ill patient up to a maximum of $50 per visit

– professional services for family counseling after the death of the terminally-ill patient, up to a maximum for all covered family members combined of $50 per visit for not more than six visits in the 12-month period after the death of the terminally-ill patient



– charges incurred for special services, such as transportation between the hospice and the patient’s home and special dietary services, up to a maximum of $25 per day and up to a lifetime maximum of $100

– Pre-admission testing (diagnostic x-ray and lab tests) when followed by admission to a hospital as an inpatient

– Second surgical opinion

• Foreign Emergency CareForeign emergency care (for foreign travel only, up to 60 days) for medically necessary hospital services or other medically necessary emergency medical services and rendered while you are traveling outside of the United States is covered at 70% of the reasonable and customary charges as determined by the claims administrator.

• Prescription Drugs, Supplies and Supplements

Comprehensive Medical coverage covers up to a 30-day supply if filled at network pharmacies and a 90-day supply if filled by mail order for prescription drugs when prescribed by a licensed physician or dentist for the treatment of an illness or injury. Ostomy and diabetic supplies are also covered. Copayment amounts are listed below:

– $0 copayment for generic drugs or $3 copayment for brand name drugs from Express Scripts through mail order

– $5 copayment for generic drugs or $10 copayment for brand name drugs at an Express Scripts participating pharmacy

– $10 plus 20% of cost for drugs at a non–Express Scripts participating pharmacy

Contact information for Express Scripts may be found in the Claims, Appeals and Administrative section.

• Vacation Leave Override

Call Meritain Health to receive an override of the 30/90-day limit if you will be on an extended vacation. You can get up to a six-month supply of prescriptions. This vacation override may be used no more than twice in any calendar year.

• Vision Care

Comprehensive Medical coverage provides R&C reimbursement for an eye examination once per calendar year. The maximum for lenses and frames is $65. Frames are covered once in a 24-month period (12 months in the case of an eligible dependent child under age 26). Lenses are covered when a change of prescription is required, but not more often than once in a 24-month period (12 months in the case of an eligible dependent child under age 26). Contact lenses in lieu of glasses are covered once in a 24-month period (12 months in the case of an eligible dependent child under age 26) up to a maximum of $100 per participant or eligible dependent.



Services Not Covered

The following list is a non-exhaustive summary of excluded services under Comprehensive Medical coverage and may change from time to time. Contact Meritain Health, the claims administrator, for more information regarding services not covered under Comprehensive Medical coverage or if you have questions about a specific service or supply. Refer to the Claims, Appeals and Administrative Information section for contact information.

• charges for a physician acting outside the scope of his license

• charges for any treatment not recommended or approved by a physician

• cosmetic services

• education, training or instruction

• electronic voice-producing machines

• employer’s medical clinic

• excess prescriptions (charges for any prescription refilled in excess of the number specified by the physician, or any refill dispensed after one year from the physician’s original order)

• experimental or investigational charges

• health education publications

• hearing aids

• injectable contraceptives

• internally-implanted, time-released drugs, including contraceptives

• luxury services

• obesity

• over-the-counter drugs

• private room

• public programs

• routine foot care

• sales tax

• self-inflicted injuries

• services provided by a relative

• speech therapy not prescribed by a physician

• standby physician services

• technical medical assistance

• telephone consultations

• transsexual surgery

• travel expenses



• treatment for medical conditions resulting from participation in a felonious activity

• treatment in U.S. government hospitals

• treatment not provided by a physician

• unnecessary hospital treatment

• vision correction surgery

• vitamins, nutritional supplements

• war-related expenses

• Workers’ Compensation claims.

Coordination of Benefits

The benefits provided under Comprehensive Medical coverage are subject to coordination of benefits rules.

If you have coverage under any other group insurance plan or government plan, you may be able to receive benefits under both plans. This will happen if both you and your spouse/domestic partner work and both of you carry family coverage through your respective employers.

The coordination of benefits rules described in this Handbook provide a general overview of these rules and are subject to change. If you have any questions about coordination of benefits, please call Meritain Health at 1-888-711-7876.

In order to receive coordinated benefits, you will need to submit a Meritain Health Coordination of Benefits form and follow the steps outlined by Meritain Health.

In addition to the information you will need from the other insurance plan, you must send copies of itemized bills or receipts to Meritain Health. Refer to the Claims, Appeals and Administrative Information section in this Handbook for contact information.

If you are the patient:

• After you receive Meritain Health’s payment, send a copy of the Explanation of Benefits (provided with your Meritain Health check) to the other insurance company

If your spouse/domestic partner is the patient:

• his/her insurance company pays first

• after you receive payment from the other insurance company, send a copy of the Explanation of Benefits (provided with the check) from the other insurance company to Meritain Health



If your child is the patient:

• if your spouse/domestic partner has a birthday that falls earlier in the year than yours, your spouse/domestic partner’s coverage pays first. Meritain Health will pay second

• if your spouse/domestic partner has a birthday that falls later in the year than yours, Meritain Health generally pays first. Your spouse/domestic partner’s coverage should pay second

• for eligible dependent children of separated or divorced parents, the plan of the parent with legal custody generally pays first. Then, if the parent with legal custody remarries, the new spouse’s plan pays second. The plan of the parent without custody pays last. This rule takes precedence over all other coordination of benefit rules


Your Comprehensive Medical coverage ends on the last day of the month in which your Partnership with SCPMG ends or you no longer meet eligibility requirements. Coverage for your dependents will end when yours does, or at the end of the month during which they become ineligible for coverage.

When coverage ends, you and your dependents may be able to continue health care coverage under COBRA provisions. Refer to the Continuation of Health Benefits under COBRA section for more information. There is no conversion option for the Comprehensive Medical coverage.

No Conversion



If you and/or your dependents lose Comprehensive Medical coverage due to termination of employment, reduction of scheduled hours, disability, death, divorce or children reaching the limiting age, Comprehensive Medical coverage may be purchased through COBRA for a maximum of 18, 29 or 36 months, depending on the reason for the termination of coverage. The coverage you purchase will generally be identical to the coverage you had. Premium rates are available from PHR Shared Services. Refer to the Continuation of Health Benefits under COBRA section of this Handbook for a general discussion of COBRA. A domestic partner who loses coverage due to one of the events listed above or as a result of dissolution of the domestic partnership will be offered continuation coverage that is equivalent to the coverage provided through COBRA. Refer to the Continuation of Health Benefits under COBRA section of this Handbook for more information.



ALTERNATE MENTAL HEALTH COVERAGE

The Alternate Mental Health coverage and the KFHP mental health benefits are both designed to provide care for acute psychiatric conditions and mental illness or disorders.

You may elect to use either:

• KFHP coverage. Mental health care must be provided through Kaiser Permanente facilities and providers (refer to the Kaiser Foundation Health Plan section of this Handbook)

• Alternate Mental Health coverage. Mental health care may be provided by any facility or provider. Certain copayments and utilization limits apply


Eligible physicians are automatically enrolled in Alternate Mental Health coverage. Dependent enrollment is not automatic; however, if you have enrolled your eligible dependents in KFHP coverage, they will be automatically enrolled in Alternate Mental Health coverage. Eligible dependents must be enrolled to receive benefits. Eligibility requirements are described under Eligibility and Enrollment in the KFHP section and the Eligible Dependents section below.

If KFHP coverage is declined, then Alternate Mental Health coverage is also declined. Refer to Declining Coverage in the KKFHP section for more information.

Eligible Dependents

Dependents eligible for Alternate Mental Health coverage include:


• your or your spouse/domestic partner’s dependent children up to age 26

• your dependent children over age 26 who were disabled before age 26 and are incapable of self-support due to a mental or physical handicap. Proof of disability may be required annually. You must apply and be approved for disabled dependent benefit by KFHP prior to your dependent child reaching benefit-limit age. Contact the Kaiser Permanente California Service Center - Disabled Dependent department at 1-858-614-3584, to obtain a Disabled Dependent application, and

• children whose parent is a dependent under your family coverage (including adopted children or children placed with your dependent for adoption; but not including foster children) if they meet the following requirements: (i) They are under age 26; (ii) They are not married and do not have a legally recognized spouse/domestic partner; (iii) They receive all of their support and maintenance from you or your spouse/domestic partner; (iv) They permanently reside with you or your spouse/domestic partner




This benefit is not continued for eligible dependents upon the death of a physician, unless purchased through COBRA. Refer to the Continuation of Health Benefits section under COBRA coverage for more information.

What the Benefit Pays

Associate Physicians hired in 2010 and earlier will continue at their current benefit levels until they attain Partner Physician status and move to Partner Physician level coverage.

Associate Physicians hired on or after January 1, 2011 generally participate in Partner Physician-level coverage.

For Partner and Associate Physicians hired on or after January 1, 2011, except as otherwise specified below, Alternate Mental Health coverage pays:

• hospitalization – 80% of the reasonable and customary cost of treatment in the area you receive services for mental illness during hospitalization for up to 31 days per calendar year

• outpatient visits – 80% of the reasonable and customary cost of treatment in the area you receive services for up to 40 visits per calendar year

• prescription drugs – 80% of the reasonable and customary cost of drugs or medicine ordered in writing or prescribed by a physician

• psychiatric care – 80%of the reasonable and customary charges.

• psychiatric therapy – 80% of the reasonable and customary cost of therapy sessions for up to 40 sessions per calendar year

• alcohol and chemical dependency – 80% of the reasonable and customary cost for outpatient individual or group therapy. This benefit does not count against the annual number of outpatient visits per calendar year

• day or night care treatment – 80% of the reasonable and customary cost of treatment in the area you receive services for the first 90 days of treatment in a calendar year. The 90-day period will be reduced by two days, however, for each full day of inpatient psychiatric care under these provisions

For an Associate Physician hired before January 1, 2011, Alternate Mental Health coverage pays:

• hospitalization – 100% of the reasonable and customary cost of treatment in the area you receive services for mental illness during hospitalization. Unlimited visits

• outpatient visits – 100% of the reasonable and customary cost of treatment in the area you receive services. Unlimited visits

• day or night care treatment – 100% of the reasonable and customary cost of treatment in the area you receive services. Unlimited visits

• prescription drugs – 100% of the reasonable and customary cost of drugs or medicine ordered in writing or prescribed by a physician

• psychiatric care – 100%of the reasonable and customary charges



• psychiatric therapy – 100% of the reasonable and customary cost of therapy sessions for up to 40 sessions per calendar year

Certain Benefits Not Provided to Associate Physicians

Alternate Mental Health benefits for Associate Physicians are subject to federally required discrimination testing. Because of this requirement, certain Alternate Mental Health benefits provided to Partner Physicians will not be available to Associate Physicians.

If you are an Associate Physician, before incurring an Alternate Mental Health service, you should contact Meritain Health at 1-888-711-7876 to determine if the benefit is available under the Alternate Mental Health benefit program provided to you.

Exclusions

The following services and supplies are not covered by the Alternate Mental Health coverage benefit; however, they may be covered under another benefit option such as KFHP coverage.

Charges not covered under this benefit include but are not limited to:

• treatment of chronic or organic psychiatric conditions or other conditions which are not subject to significant improvement through short-term therapy

• treatment of mental retardation

• testing for intelligence, aptitude or interest

• charges for psychiatric treatment or testing ordered by a court or ordered as a condition of parole or probation

For an Associate Physician hired before January 1, 2011, in addition to the exclusions listed above, charges not covered under this benefit also include:

• treatment of alcohol and chemical dependency

Note: These exclusions may change from time-to-time. Contact Meritain Health at 1-888-711-7876 if you have questions on whether a service or supply is covered.

Filing Alternate Mental Health Claims

• Claims are only required if you receive treatment or services from an out-of-network provider (an in- network provider will file reimbursement claims for you). Submit claims directly to Meritain Health, the claims administrator. Payments are sent to your home or to your provider. Claim forms may be obtained from PHR Shared Services at 1-877-608-0044 or the SCPMG Physician Portal at scpmgphysician.kp.org.

• Claims and necessary documentation must be submitted within one year of the date treatment or service is provided (even if you have left SCPMG) in order to qualify as a covered expense.



• Most types of treatment and providers are covered by this benefit. The diagnosis must be identified by a standard mental health diagnostic code. If you have any questions about a type of therapy or the type of credential the provider must have, you can request pre-authorization from the claims administrator in writing or by calling Meritain Health at 1-888-711-7876.

Maximum Benefits for Eligible Partner Physicians and Any Associate Physicians Hired After January 1, 2011

This section provides additional details about the Alternate Mental Health coverage that are specific to eligible Partner Physicians and any Associate Physicians hired after January 1, 2011.

Outpatient Visits

Alternate Mental Health coverage provides a maximum of 40 outpatient visits per calendar year.

• The outpatient visits are covered at 80% of the reasonable and customary cost of treatment in the area you receive services.

• Any doctor’s visits while hospitalized will not count against the 40 maximum outpatient visits per year.

• If a family consultation is required, the visit(s) will be charged to the person receiving the therapy. Each individual is allowed up to two such family consultations per lifetime.

• An outpatient group therapy or conjoint therapy session will be counted as a half visit for determining covered visits.

Maximum Benefits for Any Associate Physicians Hired Before January 1, 2011

This section provides additional details about the Alternate Mental Health Benefits that are specific to any Associate Physicians hired before January 1, 2011.

Outpatient Visits

Alternate Mental Health coverage provides an unlimited number of outpatient visits per calendar year.

• The outpatient visits are covered at 100% of the reasonable and customary cost of treatment in the area you receive services.

• If a family consultation is required, the visit(s) will be charged to the person receiving the therapy.

• An outpatient group therapy or conjoint therapy session will be counted as a half visit for determining covered visits.




If you terminate service with SCPMG, Alternate Mental Health coverage will terminate for you and your eligible dependents at the end of the month in which your service ends. In addition, dependents will be terminated from coverage as follows:


• domestic partner (in the event of dissolution)—at the end of the month in which PHR Shared Services receives the Enrollment Application or Change Form, provided the dissolution of domestic partner is submitted within 90 days

• children—at the end of the month:

– in which their 26th birthday occurs, or

– when they are no longer an eligible dependent

No Conversion



If you and/or your dependents lose Alternate Mental Health coverage due to termination of employment, reduction of scheduled hours, disability, death, divorce, or children reaching the limiting age, Alternate Mental Health coverage may be purchased through COBRA for a maximum of 18, 29 or 36 months, depending on the reason for the termination of coverage. The coverage you purchase will generally be identical to the coverage you had. Premium rates are available from PHR Shared Services. Refer to the Continuation of Health Benefits under COBRA section for a general discussion of COBRA. A domestic partner who loses coverage due to one of the events listed above or as a result of dissolution of the domestic partnership will be offered continuation coverage that is equivalent to the coverage provided through COBRA. Refer to the Continuation of Health Benefits under the COBRA section of this Handbook.

KAISER FOUNDATION HEALTH PLAN EMPLOYEE ASSISTANCE PROGRAM

Employee Assistance Program

The Employee Assistance Program (EAP) provides a free and confidential service for all Kaiser Permanente physicians, employees, and their eligible dependent family members. EAP professionals are available for short-term problem solving and referral on a wide range of issues generally at no charge and usually three to five sessions. EAP is not part of your medical coverage — it is a separate employee benefit and not recorded in your



medical record. Your decision to use the program is entirely voluntary and strictly confidential.

EAP professionals are licensed, trained clinicians who have years of experience working with a variety of work-related and personal issues, including the following:

• work, personal or financial stress

• alcohol or drug use

• loneliness, depression or anxiety

• marital, family, or relationship difficulties

• childcare referral assistance

• care giving for family members

• financial or legal referrals

• domestic violence or other abuse

• loss and grief

• health and wellness issues

• job performance problems

• eating problems

• work relationship issues

For scheduling convenience, consultations can be scheduled face-to-face or by phone and can be held during regular business hours: Monday through Friday, 8:30 a.m. to 5 p.m. For more information, family member eligibility, or to contact a local EAP professional, visit kp.org/eap.

PHYSICIAN WORK-LIFE SOLUTIONS

(Including External Employee Assistance and Physician Program, sometimes referred to as EAP)

Physician Work-Life Solutions is an external resource providing confidential support, information and resources for you and your eligible dependents.

All active Partner and Associate Physicians (excludes Per Diem Physicians) and their household family members are eligible for this benefit. Partner Physicians have taxable Imputed Income on the value of this benefit.

Physician Work-Life Solutions offers EAP experts on hand to offer support for the following areas:

• confidential counseling with a network of therapists, counselors and psychologists for up to five sessions per year

• stress management counseling with unlimited access to stress management coaches and tips and tools for handling stress



Physician Work-Life Solutions is a confidential resource and will not ask for personal information that may identify the caller. However, in order for your dependent to access the services, they must state that they are a family member of an SCPMG physician.

Eligible dependents must be 13 years of age or older to call in. If a dependent is under the age of 13, a parent will need to call with the child.

Please note: Physician Work-Life Solutions benefits cease at the end of the month you retire or terminate due to disability for you and your household members. You can elect to continue the EAP coverage provided by Physician Work-Life Solutions through COBRA.

You should note that Physician Work-Life Solutions offers other benefits to active Associate and Partner Physicians that may include certain legal support for certain legal services; referrals; and work-life solutions on child and elder care, educational options, community information, event planning, home improvement, buying/selling a home or relocating and assistance with shopping and locating items. These benefits are not subject to ERISA and may change from time to time.

You can access these services 24 hours a day, seven days a week by calling GuidanceResources® 1-800-505-1879 or visiting guidanceresources.com (Use Web ID: SCPMG) anytime to learn more about this program.

DENTAL COVERAGE


If you are an eligible physician, you will automatically be enrolled for Dental coverage. This benefit becomes effective the first of the month following your eligibility. You may select one of three dental benefit options. Unless you choose a different dental option within 30 days of your initial eligibility date, you will be enrolled in Delta Dental PPO.

Dependent enrollment is not automatic. Eligible dependents must be enrolled to receive benefits; however, if you have enrolled your dependents in KFHP coverage, they will be enrolled for Dental coverage and will receive coverage under the same dental program that you are enrolled in.

Eligibility requirements are described under Eligibility and Enrollment in the KFHP section and Eligible Dependents section below.

If KFHP coverage is declined, then Dental coverage is also declined. Refer to Declining Coverage in the KFHP section for more information.

Eligible Dependents

Dependents eligible for Dental coverage include:


• your or your spouse’s/domestic partner’s dependent children up to age 26 (regardless of their student, financial, and marital status)



• your dependent children over age 26 who were disabled before age 26 and are incapable of self-support due to a mental or physical handicap. Proof of disability may be required annually. You must apply and be approved for disabled dependent benefit by KFHP prior to your dependent child reaching benefit-limit age. Contact the Kaiser Permanente California Service Center - Disabled Dependent department at 1-858-614-3584, to obtain a Disabled Dependent application

• children whose parent is a dependent under your family coverage (including adopted children or children placed with your dependent for adoption; but not including foster children) if they meet the following requirements: (i) They are under age 26; (ii) They are not married and do not have a legally recognized spouse/domestic partner; (iii) They receive all of their support and maintenance from you or your spouse/domestic partner; (iv) They permanently reside with you or your spouse/domestic partner

Dental Care Options

SCPMG offers you a choice of three dental benefit options:

• Delta Dental PPO

• DeltaCare USA

• United Concordia

If you select United Concordia, you must complete an enrollment form. If you do not complete an enrollment form within 30 days of your initial eligibility, you will automatically be enrolled in Delta Dental PPO. You may obtain an enrollment form from and submit it to PHR Shared Services.

You may switch from one dental option to another once in a 12-month period by completing a new enrollment form.

Delta Dental PPO allows you to see any dentist. However, by using a PPO participating dentist, you will pay less out of pocket. DeltaCare USA and United Concordia are both prepaid group practice plans using their own panels of dentists. The dental benefit options are described below.

Summary of Dental Benefits

Dental coverage benefits are described in detail in an Evidence of Coverage (EOC) brochure that is available from your PHR Shared Services or local Permanente Human Resources department and incorporated by reference in this Handbook. The benefits may be subject to change annually due to contract revisions.

Listed below are highlights of some of the benefits available to you and your covered dependents under the three dental benefit options. Be sure to refer to the EOC for complete details.



Benefits Delta Dental PPO—Group #00814-00001 (Partner Physicians)

Examinations Covered at 100% (twice in a calendar year)

Prophylaxis with or without fluoride Covered at 100% (twice in a calendar year)

Bitewing X-rays Covered at 100% (twice in a calendar year)

Full mouth X-rays Covered at 100% (once in a calendar year)

Oral surgery, periodontics, endodontics, restorative dentistry, prosthetics

Pays 80% of usual, customary, and reasonable charges

Maximum annual benefit $1,500 per family member per calendar year (excluding children’s orthodontia). Diagnostic and Preventative Services do not count towards the maximum.

Orthodontics (limited to dependent children up to age 26)

Covered at 50% up to a lifetime maximum of $1,500 per eligible dependent

Choice of dentist To receive full benefits as indicated above, a participating member dentist or orthodontist of Delta Dental PPO must be selected

Emergency dental treatment Emergency treatment may be performed by any licensed dentist. The amount paid would be based upon procedures performed

Conversion privilege None

Benefits Delta Dental PPO—Group #00814-00002 (Associate Physicians)

Examinations Covered at 100% (twice in a calendar year)

Prophylaxis with or without fluoride Covered at 100% (twice in a calendar year)

Bitewing X-rays Covered at 100% (twice in a calendar year)

Full mouth X-rays Covered at 100% (once in a calendar year)


Pays 50% of usual, customary, and reasonable charges

Maximum annual benefit $1,500 per family member per calendar year (excluding children’s orthodontia)


Covered at 50% up to a lifetime maximum of $1,500 per eligible dependent

Choice of dentist To receive full benefits as indicated above, a participating member dentist or orthodontist of Delta Dental PPO must be selected



Emergency dental treatment Emergency treatment may be performed by any licensed dentist. The amount paid would be based upon procedures performed

Conversion privilege None

Benefits DeltaCare USA—Group #701001-0018

Examinations Covered at 100%

Office visit—after regular hours

Broken appointments—without 24-hour notice

You pay a $20 copayment

You pay $10 per 15 minutes of appointment time up to a maximum of $40 (1 hour)

Prophylaxis with or without fluoride Covered at 100% (one treatment each six-month period)

Bitewing X-rays Covered at 100% (once every 12 months)

Full mouth X-rays Covered at 100% (once every two years)

Gingivectomy or gingivoplasty You pay $75 per quadrant ($15 per tooth for treatment of less than four contiguous teeth or tooth bounded spaces)

Gingival flap procedures, including root planing

You pay $75 per quadrant


Most services covered at 100%

Removal of impacted tooth You pay $30 per partially bony tooth and $40 for completely bony tooth

Emergency (palliative) treatment of dental pain rendered by your participating dental office

You pay $5 for each treatment

Maximum annual benefit No maximum


You pay start-up fees plus $1,000. The start-up fees are approximately $350. Additional charges are covered at 100%. Retainers and head gear are not covered. Treatment is limited to 24 months.

Orthodontics (adult) You pay $1,800 co-pay. Treatment is limited to 24 months.

Choice of dentist You must select a dentist or Dental Group from a list of participating panel dentists. All covered family members must receive care from the same DeltaCare USA dentist.

Emergency dental treatment Maximum payment of $100 during each 12 calendar months. Benefit is payable only if services were rendered more than 35 miles from your participating DeltaCare USA dentist’s office. There is a $5 co-pay.

Conversion privilege Yes



Benefits United Concordia—Group #740153-000

Examinations Covered at 100%

Broken appointments—without 24-hour A “Broken Appointment” fee may apply per the dental office if appointments are canceled without 24-hour notice

Prophylaxis with or without fluoride Covered at 100% (two treatments in any 12- month period). Fluoride treatment for eligible dependent children through age 18 twice a year.

Bitewing X-rays Covered at 100% (two sets per year)

Full mouth X-rays Covered at 100% (once every three years)

Sealants Covered at 100% (one per tooth once every three years through age 10 on permanent first molars and through age 15 on permanent second molars)


Covered at 100%

Subgingival curettage, root planing Covered at 100% (one every two years for each area of the mouth).

Maximum annual benefits No maximum


You pay start-up fees of $265 plus the first $1,500. Additional charges are covered at 100%. A copayment of $240 is required for retainers. Treatment is limited to 24 months.

Orthodontics (adult) You pay a $2,000 co-pay. Covered $2,000 lifetime maximum benefit.

Choice of dentist You must select a dentist or dental group from a list of participating panel dentists. Each covered family member may choose his/her own participating dentist or dental group.

Emergency dental treatment Maximum payment of $100 for each emergency visit. Benefit is payable only if services were rendered more than 50 miles from your home.

Conversion privilege Yes



Delta Dental PPO

The maximum benefit payment per person per calendar year is $1,500 (excluding children’s orthodontia). For Partner Physicians, diagnostic and preventive services do not count toward the calendar year maximum.

The plan will pay the percentage shown in the amount above of Delta Dental PPO dentists’ usual, customary and reasonable fees:

Usual, customary, and reasonable fee means a fee that:

• is the fee usually charged for a specified service by the dentist

• is within the range of customary fees charged by dentists of similar training and experience in the local area for a specified service, and

• is reasonable considering the special circumstances of the particular case in question

Predetermination of Dental Benefits

Any time dental work is likely to cost more than $300, you should ask your dentist to send a treatment plan to Delta Dental before beginning your dental work. Delta Dental will let you and your dentist know exactly how much of the proposed charges your Delta Dental PPO coverage will pay.

Follow this procedure:

• The dentist will list each service and the related charge on the form and send it to Delta Dental. (This is called a treatment plan)

• Delta Dental will send you and the dentist a Predetermination of Benefits Statement. The statement tells you what charges are covered and how much your coverage will pay

• You should discuss the treatment plan and the costs with your dentist before treatment begins

• If the treatment plan changes, the benefits paid by Delta Dental PPO may change. If the change is significant, your dentist should send a new Attending Dentist’s Statement to Delta Dental

• If you use a non-participating dentist, give him or her a Delta Attending Dentist’s Statement form. (Delta Dental PPO dentists already have these forms)


The Delta Dental PPO coverage does not cover services for:

• congenital malformations

• developmental malformations

• cosmetic surgery

• purely cosmetic reasons



• the replacement and/or repair of an orthodontic appliance furnished under this program

• restoring tooth structure lost from wear

• rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion

• stabilizing teeth

• adult orthodontia

• jaw realignment

• dental implants

• prosthodontic services or devices or any single procedure started before the patient became eligible for this benefit

• prescribed drugs and anesthesia

• hospital costs and related professional fees

• services provided under any governmental program (except Medicaid)

• experimental procedures

Additional exclusions and limitations may apply.

Please note: This list is subject to change from time-to-time. Refer to your EOC or contact Delta Dental for more information.

Certain Delta Dental PPO Benefits Not Provided to Associate Physicians

Delta Dental PPO benefits for Associate Physicians are subject to federally required discrimination testing. Because of this requirement, certain Delta Dental PPO benefits provided to Partner Physicians will not be available to Associate Physicians. Contact Delta Dental if you have questions on what the Delta Dental PPO will cover.

Filing Claims

Approximately 90% of California dentists are Delta Dental PPO member dentists. Before starting treatment, advise your dentist that you are a member of the SCPMG Delta Dental PPO Program, Group Number 00814-00001.

If you do not use a Delta Dental PPO dentist, your coverage will pay 80% of the Delta Dental PPO table of allowances rather than 80% of the usual, customary and reasonable fees. This payment usually approximates 50% of non-Delta Dental PPO dentists’ fees.

Claim forms are available at Delta Dental PPO dentists’ offices. Most Delta Dental PPO members will file the claim on your behalf.

Coordination of Coverage

If you or one of your eligible dependents is eligible for dental benefits under another group plan, the claims administrator will coordinate the benefits payable under this plan with those of the other plan. The combined benefits payable to



you or your eligible dependent(s) under the coordinated group dental plans may not exceed 100% of the allowable expenses incurred during the calendar years.


If you terminate service with SCPMG, Delta Dental PPO coverage will terminate for you and your eligible dependents at the end of the month in which your service ends.






If you and/or your dependents lose Delta Dental PPO coverage due to termination of employment, reduction of scheduled hours, disability, death, divorce or children reaching the limiting age, Delta Dental PPO coverage may be purchased through COBRA for a maximum of 18, 29, or 36 months, depending on the reason for the termination of coverage. The coverage you purchase will generally be identical to the coverage you had. Premium rates are available from PHR Shared Services. Refer to the Continuation of Health Benefits under COBRA section of this Handbook for a general discussion of COBRA. A domestic partner who loses coverage due to one of the events listed above or as a result of dissolution of the domestic partnership will be offered continuation coverage that is equivalent to the coverage provided through COBRA. Refer to the Continuation of Health Benefits under the COBRA section of this Handbook for more information.

No Conversion


DeltaCare USA

The following is a summary of key provisions of the DeltaCare USA benefit option. The terms of the DeltaCare USA benefit option are contained in the Evidence of Coverage (EOC), which is incorporated by reference in this Handbook. Under the DeltaCare USA benefit option, you must receive your treatment from one of their panel of dentists. Your family members can use the same dental office, but they are not required to do so. You and your family members may collectively select a maximum of three different primary care network dentists. A list of participating dental offices is included in the DeltaCare USA enrollment material.



The maximum annual benefit is unlimited and most listed procedures are provided with no charge to the member. Included are diagnostic and preventive services, restorative dentistry, crowns and bridges, pontics, periodontics, endodontics, prosthetics, oral surgery, space maintainers, and X-rays.

Adult orthodontic treatment is available with an $1,800 co-pay. Orthodontic treatment is also available to eligible dependent children provided treatment begins before age 19; you pay the start-up fees of approximately $350 plus the first $1,000, and DeltaCare USA pays the balance. Under DeltaCare USA, orthodontic treatment must be completed within 24 months.

A representative list of covered services is provided with the enrollment material. In general, most procedures are provided at no additional charge. Exceptions are listed in the Description of Benefits and Copayments for DeltaCare USA.

Emergency Services

If you are more than 35 miles from your selected dental office, you may select any dentist and receive palliative care. You will be reimbursed up to $100 per member per year, after paying a $5 co-pay. If you are closer than 35 miles to your selected dental office, call that office to reach the 24-hour answering service to arrange for treatment.

For any questions or problems, call DeltaCare USA at 1-800-422-4234 or PHR Shared Services at 1-877-608-0044.

Exclusions

DeltaCare USA does not cover the following:

Please note: This list is subject to change from time to time. Refer to your Evidence of Coverage of contact DeltaCare USA for more information.

• procedures not specifically listed as a covered benefit

• cosmetic dental care

• general anesthesia and the services of a special anesthesiologist

• fees that are collectible from a third party

• hospital charges of any kind

• treatment of fractures and dislocations

• loss or theft of dentures, space maintainers, crowns, or bridgework

• lost, stolen or broken orthodontic applications

For a complete list of exclusions, refer to your DeltaCare USA schedule of benefits.



Service Limitations

Services are limited per individual as follows:

Please note: This list is subject to change from time-to-time. Refer to your Evidence of Coverage or contact DeltaCare USA for more information.

• prophylaxis limited to one treatment in any six-month period

• full upper and/or lower dentures not to exceed one each in any five-year period

• upper and/or lower partial dentures not to exceed one each in a five-year period unless necessary due to natural tooth loss and where the addition to an existing partial is not feasible

• denture relines limited to one per denture during any 12 consecutive months

• periodontal treatments limited to four quadrants per 12 consecutive months

• no more than one series of four films in any six-month period for bitewing X-rays

• one set of full mouth X-rays per 24 consecutive months

• crowns and bridges not to be replaced within five years from initial placement

For a complete list of service limitations, see your DeltaCare USA schedule of benefits.

Filing Claims

No claim forms are required. Delta Dental provides each DeltaCare USA panel office with a listing of those eligible who have selected that office. The office handles all claims administration.


If you or one of your eligible dependents is eligible for dental benefits under another group plan, the claims administrator will coordinate the benefits payable under this plan with those of the other plan. The combined benefits payable to you or your eligible dependent(s) under the coordinated group dental plans may not exceed 100% of the allowable expenses incurred during the calendar year.


If you terminate service with SCPMG, DeltaCare USA coverage will terminate for you and your eligible dependents at the end of the month in which your service ends.








If you and/or your dependents lose DeltaCare USA coverage due to termination of employment, reduction of scheduled hours, disability, death, divorce or children reaching the limiting age, DeltaCare USA coverage may be purchased through COBRA for a maximum of 18, 29 or 36 months, depending on the reason for the termination of coverage. The coverage you purchase will generally be identical to the coverage you had. Premium rates are available from PHR Shared Services. Refer to the Continuation of Health Benefits under COBRA section of this Handbook for a general discussion of COBRA. A domestic partner who loses coverage due to one of the events listed above or as a result of dissolution of the domestic partnership will be offered continuation coverage that is equivalent to the coverage provided through COBRA. Refer to the Continuation of Health Benefits under COBRA section of this Handbook for more information.

Conversion

Conversion to an individual policy is available under this coverage. Conversion information is available directly from DeltaCare USA at 1-800-422-4234.

United Concordia

The following is a summary of key provisions of the United Concordia benefit option. The terms of the United Concordia benefit option are contained in the Evidence of Coverage (EOC), which is incorporated by reference in this Handbook.

Under the United Concordia benefit option, you must receive treatment from a member of their panel of dentists. You and your family members may choose your own participating dental office. A list of participating dental offices is included in the plan enrollment material.

The maximum annual benefit is unlimited and most listed procedures are provided with no additional charge to the member. Included are diagnostic and preventive services, restorative dentistry, crowns and bridges, pontics, periodontics, endodontics, prosthetics, oral surgery, space maintainers, and X-rays.



Adult orthodontic treatment is available with a $2,000 co-pay. Orthodontic treatment is also available to eligible dependent children provided treatment begins before age 18; you pay the start-up fees of $265 plus the first $1,500 and United Concordia pays the balance. There is a copayment of $240 required for retainers. Orthodontic treatment must be completed within 24 months.

A schedule of benefits outlining covered services is provided with the enrollment material. In general, most procedures are provided at no additional charge. Any exceptions are listed in the Schedule of Dental Benefits provided by United Concordia.

Services not on the list are available at the dentist’s usual and customary fees.

Emergency Services

You may obtain emergency treatment at any time by calling your selected dental office. If your dental office is unavailable, you should contact the United Concordia Customer Service department at 1-800-937-6432 for assistance.

If the emergency occurs outside United Concordia’s regular business hours and your dental office is unavailable, palliative dental services may be obtained from any licensed dentist. You are also covered for emergency palliative dental treatment while temporarily more than 50 miles from your home. You will be reimbursed up to $100 for each emergency visit. In either case, an itemized bill and a cover letter explaining the emergency should be submitted to United Concordia within 30 days of the emergency treatment date to be considered for reimbursement.

For any questions or problems, call United Concordia at 1-800-937-6432 or PHR Shared Services at 1-877-608-0044.

Alternative Treatment

Occasionally there is more than one way to treat a dental condition successfully. If you select an alternative treatment plan, the dental benefit will be based on the usual, customary, and reasonable charge for the service that is covered. You will be responsible for any difference between the covered service and the alternate treatment, plus any copayment.


United Concordia does not cover:

Please note: This list is subject to change from time to time. Refer to your Evidence of Coverage or contact United Concordia for more information.

• procedures not specifically listed as a covered benefit

• services not provided by your selected dental office and not preauthorized by United Concordia (including specialty services)



• services that are not clinically necessary to maintain or improve dental health

• charges for services required because the patient did not follow a documented prescribed course of treatment

• any treatment started before coverage under United Concordia began or after United Concordia coverage terminates

• consultation by a specialist for services that are not covered by United Concordia

• services that do not meet accepted standards of dental practice, are experimental or investigative in nature or are considered enhancements to standard dental care

• hospitalization costs for any dental procedures

• prescription or non-prescription drugs, home care items, vitamins, or dietary supplements

• elective surgery

• implants

• services or supplies that are cosmetic in nature, including (but not limited to) bonding, bleaching teeth, personalization of dentures and posterior composites (white fillings)

• procedures to alter, restore, or maintain occlusion, or to change vertical dimension

• consultation and treatment (including appliances) for TMJ

• replacement of dentures, appliances, crowns or bridgework due to loss or theft

• duplicate prosthetic device or appliance

• fees collectible from a third party

• replacement or repair of orthodontic appliances, orthodontic extractions, special orthodontic appliances, retreatment of orthodontic cases, changes in orthodontic treatment necessitated by patient neglect or orthodontic treatment that exceeds 24 months

Service Limitations

Services are limited per individual as follows:

Please note: This list is subject to change from time-to-time. Refer to your Evidence of Coverage or contact United Concordia for more information.

• two sets of bitewing X-rays per year

• one set of full mouth X-rays every three years

• denture relining and rebasing is covered if provided within six months of insertion by the same dentist



• periodontal scaling and root planing limited to one every two years for each area of the mouth

• referrals for specialty care, limited to orthodontics, oral surgery, periodontics, endodontics and pedodontics

You must remain covered under the United Concordia benefit option while your eligible dependent child is receiving orthodontic treatment; otherwise, there will be a pro-rata charge for all unfinished work at the time your coverage ends.

Additional exclusions and limitations may apply. Refer to your Evidence of Coverage.

Filing Claims

No claim forms are required. United Concordia provides each panel dentist’s office with a listing of those eligible who have selected that office. The office handles all claims administration.


If you or one of your eligible dependents is eligible for dental benefits under another group plan, the claims administrator does not coordinate with other plans, so this benefit is primary under all circumstances.


If you terminate service with SCPMG, United Concordia coverage will terminate for you and your eligible dependents at the end of the month in which your service ends.






If you and/or your dependents lose United Concordia coverage due to termination of employment, reduction of scheduled hours, disability, death, divorce, or children reaching the limiting age, United Concordia coverage may be purchased through COBRA for a maximum of 18, 29, or 36 months, depending on the reason for the termination of coverage. The coverage you purchase will generally be identical to the coverage you had. Premium rates are available from PHR Shared Services. Refer to the Continuation of Health Benefits under COBRA section of this Handbook for a general discussion



of Cobra. A domestic partner who loses coverage due to one of the events listed above or as a result of dissolution of the domestic partnership will be offered continuation coverage that is equivalent to the coverage provided through COBRA. Refer to the Continuation of Health Benefits under COBRA section of this Handbook for more information.

Conversion

Conversion to an individual policy is available under this coverage. Conversion information is available directly from United Concordia at 1-800-937-6432.

Continuation of Health Benefits under COBRA

Under the federal law known as the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), eligible Associate and Partner Physicians (excludes Per Diem Physicians) and their eligible family members (including their spouse/domestic partner and their eligible children) are entitled to continue group health coverage under certain circumstances when coverage would otherwise end by timely electing COBRA, provided they pay the full group rate plus a small administrative fee each month.

The following is intended to inform you, in a summary fashion, of your rights and obligations under the continuation coverage provisions of COBRA. You, your spouse/domestic partner, and your eligible children should take the time to read this notice carefully. For more information about your rights and obligations under the plan and under federal law, contact Wageworks, our third-party administrator, at 1-877-864-9546 or Kaiser Permanente, the Plan Administrator, at the following address and/or phone number:

KFHP, Inc. One Kaiser Plaza, 20th Floor Oakland, CA 94612Phone: 510-271-5940

You can continue coverage under COBRA for the following plans, if eligible:

• Medical plans:

– KFHP (excluding Special Dependent)

– Supplemental Medical

– Comprehensive Medical

– Alternate Mental Health

• Dental plans:

– Delta Dental PPO

– DeltaCare USA

– United Concordia

• Health Care Spending Account

• Employee Assistance Program



California law extends the self-payment coverage period to you and your dependents for the full period permitted under federal COBRA law. The state-extended coverage, known as CalCOBRA, becomes available only after you have exhausted federal COBRA and extends self-paid medical coverage only, for up to an additional 18 months (not including Supplemental Medical) for a combined maximum coverage period of 36 months from the date of your initial qualifying event. The state-extended coverage applies if you, your spouse/domestic partner, and your eligible children lose group health plan coverage as a result of a termination of employment or reduction of hours.

You Have a Change in Eligibility

You, your spouse/domestic partner, and your eligible children, covered under the SCPMG-sponsored plans, are eligible to continue medical and dental coverage if your eligibility status changes for one of the reasons described below:

• You leave SCPMG for any reason (except for removal due to gross misconduct)

• You no longer meet the eligibility requirements for benefits

You may also be eligible to continue your participation in a Health Care Spending Account.

You may elect to continue coverage for up to 18 months for yourself, your covered spouse/domestic partner, and your eligible children if your coverage ends. Your coverage under the SCPMG-sponsored plans will continue through the end of the month in which any of the above events occur. Your COBRA coverage will become effective on the first day of the following month, provided you make a timely COBRA election and payment.

Please note: Individuals who decline COBRA coverage when first eligible may not enroll for COBRA coverage later based on the same loss of coverage event.

During the period you continue coverage, an open enrollment period will be made available. You will have an opportunity to change or add medical and dental options. You may also drop coverage for a family member or add the following dependents during any open enrollment:

• Any new eligible dependents you acquire

• Any eligible dependents you declined to cover before you elected continued coverage

Special Enrollment Rights

If you decline COBRA coverage for your spouse/domestic partner and/or your eligible children and they subsequently lose their other coverage for any reason, you may request to enroll them in COBRA no later than 31 days after the date their other coverage terminates.



If You Have a Change in Family Status

Your spouse/domestic partner and your eligible children can continue coverage for up to a total of 36 months if coverage ends due to one of the following events:

• You divorce, annul your marriage, or legally separate from your spouse, or terminate your domestic partnership

• Your children no longer qualify for dependent coverage under the terms of the plan

If one of these qualifying events occurs after the start of the initial 18-month COBRA coverage period, your spouse/domestic partner and your eligible children can apply for an additional 18 months of coverage under COBRA. It is your or your dependents’ responsibility to notify Wageworks within 60 days of the occurrence of any of these events in order to be eligible for this extended COBRA coverage.

If You Are Called to Military Service

If you are absent from employment for more than 30 days by reason of service in the Uniformed Services, you may elect to continue medical and dental coverage for yourself, your spouse/domestic partner, and your eligible children in accordance with the Uniformed Services Employment and Reemployment Rights Act of 1994, as amended (USERRA).

The terms “Uniformed Services” or “Military Service” mean the United States Armed Forces, the Army National Guard and the Air National Guard when engaged in active duty for training, inactive duty training, or full-time National Guard duty, the commissioned corps of the Public Health Service, and any other category of persons designated by the President of the United States in time of war or national emergency.

If qualified to continue medical and dental coverage under USERRA, you may elect to continue coverage by notifying the Plan Administrator in advance, and providing payment of any required contribution for your medical and dental coverage. This may include the amount the plan administrator normally pays on your behalf. If your Military Service is for a period of time less than 31 days, you may not be required to pay more than the regular contribution amount, if any, for continuation of medical and dental coverage.

You may continue medical and dental plan coverage under USERRA for up to the earlier of:

• The 24-month period beginning on the date of your absence from work; or

• The day after the date on which you fail to apply for, or return to, a position at SCPMG

Regardless of whether you continue medical and dental coverage under this policy, if you return to work with SCPMG in an eligible position, you and your eligible dependents who were enrolled in medical and/or dental



coverage before your Military Service will be reinstated under the plan. No exclusions or waiting period may be imposed on you or your eligible dependents in connection with this reinstatement, unless a sickness or injury is determined by the Secretary of Veterans Affairs to have been incurred in, or aggravated during, the performance of military service.

For more information on policies regarding Military Leaves, contact PHR Shared Services.

If You Die

Coverage may be continued by your covered spouse/domestic partner and eligible children for up to a total of 36 months.

If You or Your Dependents Are Disabled

If you, your spouse/domestic partner, or an eligible child is determined to be disabled as defined by the Social Security Act prior to the qualifying event or during the first 60 days of COBRA coverage, COBRA may be extended from 18 months up to a total of 29 months at a higher premium. You must notify Wageworks within 60 days of the receipt of your Social Security award letter, and no later than the expiration of your initial 18-month coverage period. You must also notify Wageworks within 60 days of the date Social Security determines that the formerly disabled individual is no longer disabled.

COBRA Election Procedures

You, your spouse/domestic partner, and your eligible children who lose medical and/or dental coverage due to your loss of eligibility will be notified of COBRA election privileges by Wageworks. If coverage is lost due to your death, Wageworks will provide COBRA election notification to your eligible dependents in order to initiate COBRA coverage. If an eligible dependent will lose coverage due to divorce, legal separation, annulment, termination of a domestic partnership, or attainment of the dependent age limits, you must notify PHR Shared Services, within 31 days of the qualifying event. PHR Shared Services will notify Wageworks of your eligible dependent’s loss of coverage to exercise their COBRA election privileges.

You, your spouse/domestic partner, and your eligible children will be provided with a COBRA election form, which you must each fill out and return within 60 days of the notification date shown on the form, or loss of coverage date, if later. If the form is not returned within 60 days of the notification date or the loss of coverage date, if later, Wageworks will assume that you (or, if applicable, your eligible family member) have declined coverage.



Consider Your COBRA Decision Carefully

Please examine your options carefully before declining this coverage. If you do not elect COBRA coverage when eligible, you cannot elect it in the future. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace.

You have 60 days to make a decision regarding continuation of group coverage through COBRA. After 60 days you may not change your initial election to continue or not continue coverage through COBRA, although you may stop your COBRA coverage at any time.

Benefits under COBRA

Your benefits while you are enrolled in COBRA coverage will be the same as the coverage for similarly situated participants. Therefore, if there are any changes to the plan for similarly situated participants, including changes to the cost, your benefits will also change. COBRA premium rates are subject to change on an annual basis.

Under COBRA, you, your spouse/domestic partner, and your eligible children, have the same enrollment privileges that apply to similarly situated active physicians. You may enroll eligible dependents during the year if there is a qualified change in family status or at open enrollment, and you can change coverage at open enrollment, subject to the same rules that apply to active physicians. You may drop COBRA coverage at any time. Once you discontinue COBRA coverage, you may not elect it at a later date, or re-enroll.

You will be billed within 31 days of electing COBRA. Your first payment due will include any outstanding premiums retroactive to your initial COBRA eligibility date. Payment for this coverage must be paid in full within 45 days of your election. Partial payments will not be accepted. Subsequent payments will be due the first of the month with a 30-day grace period. If payment is not postmarked within 30 days of the due date, coverage will be terminated retroactive to the first of that month. If for any reason you do not receive a monthly invoice, you are still responsible for a timely payment of the full monthly COBRA premium.

Marketplace Individual Coverage

You may decide to enroll in Marketplace Individual coverage instead of COBRA. You have a special enrollment period of 60 days from the time you lose your job-based coverage to enroll in the Marketplace. After 60 days you will not be able to enroll using special enrollment.

However, you will have an opportunity to enroll in Marketplace coverage during the annual Marketplace open enrollment period.

To find out more about enrolling in the Marketplace, such as when the next open enrollment period will be and what you need to know about qualifying events and special enrollment periods, visit HealthCare.gov.



If you sign up for COBRA continuation coverage, you can switch to a Marketplace plan during a Marketplace open enrollment period. You can also end your COBRA continuation coverage early and switch to a Marketplace plan if you have another qualifying event, such as marriage or birth of a child. However, if you terminate your COBRA continuation coverage early without another qualifying event, you will have to wait until the next open enrollment period to enroll in Marketplace coverage. For full details about your COBRA coverage rights, contact PHR Shared Services.

Employee Assistance Program COBRA Continuation

You and your spouse/domestic partner and eligible children may also continue your Employee Assistance Program through COBRA if your qualifying event is termination or loss of benefit eligibility.

When Coverage Ends

COBRA coverage stops before the end of the applicable time period if any of the following situations occur:

• You, your spouse/domestic partner, and your eligible children become covered under any other group medical or dental plan

• You, your spouse/domestic partner, and your eligible children become entitled to Medicare benefits after the qualifying event

• You fail to pay the required premium on time

• SCPMG terminates all of its group health plans

• You, your spouse/domestic partner, and/or your eligible children are on a COBRA disability extension and Social Security determines that the formerly disabled individual is no longer disabled

When your COBRA coverage ends, you may be eligible to convert to an individual medical and/or dental plan. In addition, your spouse/domestic partner, and your eligible children may be eligible to extend coverage under COBRA for an additional 18 months, or convert to an individual medical and/or dental plan. For full details about your COBRA coverage rights, contact PHR Shared Services.

COBRA coverage will be provided as required by law. If the law changes, your rights will change accordingly.



HEALTH CARE NOTICES

Women’s Health and Cancer Rights Act

Pursuant to the Women’s Health and Cancer Rights Act, the medical plans provided under the Kaiser Foundation Health Plan (KFHP) and described in this Handbook provide benefits for the restoration of breasts in connection with a mastectomy, specifically:

• reconstruction of the breast on which the mastectomy was performed,

• surgery and reconstruction of the other breast to produce a symmetrical appearance, and

• prostheses and treatment of physical complications for all stages of mastectomy, including lymphedemas (swelling associated with the removal of lymph nodes).

KFHP will determine the manner of coverage in consultation with the patient and the attending doctor. Coverage for breast reconstruction and related services will be subject to any deductibles and coinsurance amounts consistent with those that apply to other health benefits under the plan.

Newborns’ and Mothers’ Health Protection Act

Pursuant to the Newborns’ and Mothers’ Health Protection Act, the medical plans provided under the KFHP and described in this Handbook provide maternity benefits including expenses for you or your enrolled spouse/domestic partner or child.

This federal law provides that hospital stays for services for the mother and newborn child cannot be less than 48 hours following a normal vaginal delivery, or 96 hours following a caesarean birth, unless the attending physician, after consulting with the mother, discharges the mother or newborn child earlier. The physician is not required to pre-certify the maternity hospital stay if it falls within these limits.

Health Insurance Portability and Accountability Act—Privacy of Health Information

SCPMG and KFHP take the security of your health information very seriously. SCPMG maintains a Notice of Privacy Practices that describes the circumstances in which SCPMG may use or disclose your health information. This Notice of Privacy Practices is available at kp.org. For additional information or to obtain a paper copy of the Notice of Privacy Practices, please contact Member Services at 1-800-464-4000.

Genetic Information Nondiscrimination Act

SCPMG and KFHP will not request, require, or otherwise collect genetic information pertaining to you or your family members for the purposes of limiting your benefits or for any other purpose in violation of the Genetic Information Nondiscrimination Act. For more information, please contact Member Services at 1-800-464-4000.

Michelle’s Law

Michelle’s Law extends health coverage under group health plans for dependent college students who take a medically necessary leave of absence from school for a period of up to one year. You must request certification of medical necessity from the treating physician and this must be provided to the health plan.



Eligibility

A “qualified dependent” means a dependent child who meets the definition for full-time student dependent eligibility under a benefit plan described in Section I of this Handbook. To be eligible for coverage under Michelle’s Law, the dependent student must have been covered under the plan immediately before the first day of the medically necessary qualified leave. A “qualified leave of absence” means:

• a leave of absence from a post-secondary institution that begins while the child is suffering from a serious illness or injury,

• the leave is medically necessary as certified by the treating physician, and

• the leave results in the child losing student status for purposes of coverage under the plan

If approved, the dependent will be entitled to the same level of benefits during the medically necessary leave of absence as would have been provided to him/her as a full-time student. Eligibility under Michelle’s Law will be extended for up to one (1) year or until the coverage would otherwise have terminated pursuant to the terms and conditions of the plan, whichever occurs first. California insurance law may provide similar rights for certain benefits described in this Section I. If you have any questions about your rights under either Michelle’s Law or California law, please contact the Member Services at 1-800-464-4000.

California Healthy Workplaces Healthy Families Act of 2014

Governor Brown signed into California law AB1522 the “Healthy Workplaces, Healthy Families Act of 2014.” The new sick leave law began January 1, 2015, but the right to accrue and take sick leave did not take effect until July 1, 2015. An employee qualifies for paid sick leave by working in California for an employer on or after January 1, 2015, for at least 30 days within a year and by satisfying a 90-day employment period.

This Act requires employers to provide no less than three days of paid sick leave per anniversary year. Employees can take paid leave for themselves, for an eligible family member or for any individual related by blood or affinity whose close association with the employee is the equivalent of a family relationship due to illness or for the diagnosis, care or treatment of an existing health condition or preventative care. In addition, employees can take time for specified purposes if the employee is a victim of domestic violence, sexual assault or stalking.

• Family members include the employee’s parent, child, spouse, registered domestic partner, grandparent, grandchild, and sibling

• Preventive care would include annual physicals or flu shots

• For partial days, the employer can require you to take at least two hours of leave, but otherwise the determination of how much time is needed is left to the employee

SCPMG will comply with any applicable local ordinances providing for additional paid sick leave benefits.

Special Enrollment Rights

If you or your eligible dependent(s) have medical coverage outside of Kaiser Permanente and you or your dependent(s) subsequently lose your other coverage involuntarily, you or your eligible dependent(s) may enroll in a Kaiser Permanente-sponsored medical plan, provided your enrollment request is received no later than 31 days after the date the other coverage terminated.

If you or your eligible dependent(s) are enrolled in Medicaid or your state’s Children’s Health Insurance Program (CHIP) and lose medical coverage under Medicaid or CHIP, then you and/or your eligible dependent(s) may enroll in a Kaiser Permanente-sponsored medical plan, provided your enrollment request is received no later than 60 days after the date your Medicaid or CHIP coverage terminated.

Finally, if you or your eligible dependent(s) become eligible for premium assistance under Medicaid or CHIP, and you or your eligible dependent(s) are not already enrolled in a Kaiser Permanente-sponsored medical plan, you and your eligible dependent(s) may enroll in a Kaiser Permanente-sponsored medical plan, provided your enrollment request is received no later than 60 days after being determined eligible for premium assistance.


DISABILITY INCOME BENEFITS

SECTION II

107

DISABILITY INCOME BENEFITS 108SECTION: II


DISABILITY INCOME BENEFITS

The Disability Income plans in combination with the SCPMG Sick Leave pay programs, are designed to provide you with continued full or partial income in the event of a covered disabling illness or injury. The amount and duration of the benefits are based on your length of service and physician category.

Sick Leave Pay Programs

SCPMG provides the following benefits at no cost to you (as specified in the SCPMG Partnership Agreement/Rules and Regulations):

• Acute Sick Leave covering all Associate and Partner Physicians, (excludes Per Diem Physicians)

• Accumulated Acute Sick Leave covering Partner Physicians

• Chronic Sick Leave covering Partner Physicians

• Accumulated Chronic Sick Leave covering Special Category Physicians

Refer to the Paid Time-Off section for a description of SCPMG’s Sick Leave pay programs.

Any additional benefits required by federal, state, or local laws that are not described here will be provided to you in accordance with the law.

Disability Income Plans

SCPMG also offers the following disability benefits:

• Short-Term Disability available to Associate Physicians and special category physicians at no cost

• Compensation Continuance Program covering Partner Physicians

• Long-Term Disability available to eligible Partner and Associate Physicians. Associate Physicians must pay a monthly premium

• Supplemental Individual Disability Insurance available to eligible Associate and Partner Physicians to supplement your Long-Term Disability insurance

ERISA governs Short-Term Disability, Long-Term Disability, and Supplemental Individual Disability Insurance.

For the benefit plans governed by ERISA, this Benefits Handbook serves as your Summary Plan Description (SPD). The terms and conditions of these benefits are specified in the official plan documents and insurance contracts. In case of any omission or conflict between what is written in this SPD and in the official plan documents or the insurance contracts, the official plan documents and insurance contracts, as applicable, always govern.



The Sick Leave Pay programs and the Compensation Continuance Program are not subject to ERISA. For these benefit programs that are not subject to ERISA, in the case of any omission or conflict in this handbook, the official plan document (if any), the SCPMG Partnership Agreement, the SCPMG Rules and Regulations, and the minutes of SCPMG’s Board of Directors and the minutes of the Medical Directors, as applicable, always govern.

SHORT-TERM DISABILITY INSURANCE

Eligibility

All actively-at-work Associate Physicians (excludes Per Diem Physicians) are eligible for Short-Term Disability (STD) Insurance.

The insurer is Life Insurance Company of North America, a CIGNA company.

The terms of the Short-Term Disability Insurance plan are contained in a member certificate (also referred to as the insurance contract in this Handbook).

You can obtain a copy of the member certificate by contacting PHR Shared Services at 1-877-608-0044.

Benefits

The coverage provides a benefit equal to 50% of your monthly base pay to a maximum benefit of $3,462 per week. This is equivalent to a monthly benefit of $15,000.

There is a minimum benefit of $25 per week.

STD benefits will be determined by your monthly Base Compensation (prorated to your work schedule) in effect on the date immediately preceding the date your disability began. Any increase in your monthly Base Compensation that occurs during the first six months of your disability will be reflected in your STD benefit.

For Associate Physicians with a hire date prior to July 1, 2014:

Benefits are payable from the 31st calendar day of disability due to injury or illness. Payments continue for up to 22 weeks for each period of disability, provided CIGNA certifies that you are disabled.

For Associate Physicians with a hire date on or after July 1, 2014:

Benefits are payable from the 15th calendar day of disability due to injury or illness. Payments continue for up to 22 weeks for each period of disability, provided CIGNA certifies that you are disabled.



When Benefits End

STD benefits will end on the earliest of:

• the date you earn more than 80% of your Indexed Covered Earnings,

• the date CIGNA determines you are not disabled,

• the end of the maximum benefit period, or

• the date of your death

Definition of Disability

In order to be considered disabled for purposes of disability insurance coverage, you must be unable to perform all of the material duties of your regular occupation or be unable to earn more than 80% of your Indexed Covered Earnings solely due to injury or sickness.

Pre-Existing Condition Limitation

If your STD insurance has been in effect for less than 12 months, no benefits will be paid as a result of a pre-existing condition. A pre-existing condition means any injury or sickness for which you incurred expenses; received medical treatment, care, or services, including diagnostic measures; received prescription drugs or medicines; or consulted with a physician within three months of your coverage start date. Refer to your certificate for further details.

Successive Periods of Disability

Once you are eligible to receive STD benefits, periods of disability due to the same or related causes will be considered the same period of continuous disability if you return to active service for more than one day but less than 14 consecutive days.

A disability that results from unrelated causes, or a disability that occurs after your coverage under this STD insurance ends, will be considered a separate period of disability.

Social Security Disability Benefit

The amount of your STD benefit is not integrated with Social Security. If you become disabled and are certain that your disability will be of a permanent or indefinite duration, CIGNA will assist you in applying for your Social Security Disability benefit, or you may apply for your Social Security Disability benefit by contacting the Social Security Administration directly.



State Disability

Associate Physicians are eligible for State of California Disability benefits. These benefits are not integrated with STD insurance. Claims can be filed online by visiting edd.ca.gov/Disability/SDI_Online.html. For more information, contact the California State Disability Insurance office at 1-800-480-3287.

Work Incentive Benefit

The Work Incentive Benefit permits you to return to your regular occupation on a part-time basis, or to any other occupation on a full-time or part-time basis. However, your STD benefit may be reduced if the total of your STD benefit and current earnings exceed 100% of your monthly Base Compensation used to determine your STD benefit.

Current Earnings

Included in current earnings are any wages or salary for work performed while you are receiving STD benefits.

Rehabilitation Program

You may qualify to participate in the rehabilitation program if CIGNA determines that you are a suitable candidate for rehabilitation. Through this program, CIGNA will provide, arrange and authorize vocational or physical rehabilitation services for you. While you participate in the program, you could receive payment of your:

• medical expenses

• education expenses

• moving expenses

• accommodation expenses

• family care expenses

Reasonable Accommodation Benefit under STD Plan

If you are a disabled Associate Physician, SCPMG may provide reasonable accommodation so that you are able to return to work. A reasonable accommodation is any modification or adjustment to a job, an employment practice, or the work environment that makes it possible for a disabled person to perform the material duties of any occupation without causing undue hardship on SCPMG. SCPMG may receive reimbursement from any expenses incurred in providing the reasonable accommodation if the following conditions are met:

• the accommodation is made on your behalf and results in your ability to return to any occupation with SCPMG,

• the accommodation is approved in writing by CIGNA before it is implemented or any expense incurred, and



• the accommodation meets the federal standards of a reasonable accommodation as detailed in the Americans With Disabilities Act of 1990, as amended

Exclusions

STD benefits are not payable for a disability that results, directly or indirectly, from:

• suicide, attempted suicide, or intentionally self-inflicted injuries

• war or any act of war, whether declared or undeclared

• serving on full-time active duty in any armed forces

• terrorism or active participation in a riot

• commission of a felony

• revocation, restriction, or non-renewal of your license, permit certification necessary to perform the duties of your occupation

• cosmetic surgery or surgical procedure that is not medically necessary. Medically necessary means that the surgery is prescribed by a doctor as required treatment of the injury or sickness, and is appropriate according to conventional medical practice for the injury or sickness.

• any period of disability during which you are incarcerated in a penal or correctional institution

Termination of Insurance

Your STD insurance coverage terminates on the date any of the following situations occur:

• you are no longer in active service

• you no longer qualify for coverage

• the policy is terminated

During an approved leave of absence, STD insurance coverage can continue for up to 12 months if you pay the required premiums.

No Conversion


Claims

You will receive instructions from PHR Shared Services. Prompt response to the instructions will help ensure timely payment of your disability benefits.

Cost

SCPMG pays for the cost of this benefit.



Tax Implications

The value of the premium for STD insurance is considered Imputed Income and appears as taxable income on your paycheck. Since you pay taxes on the value of the premium, you will not be required to pay taxes on the disability benefit amount provided to you by CIGNA. Since the value of the premium depends on base earnings and work schedule, the impact to taxable income will be different for each Associate Physician.

Continuation of Other Benefits

SCPMG will continue to pay for benefits provided at SCPMG expense during the period of your STD leave, as long as you remain employed. Associate Physicians who pay for certain benefits will be able to continue these benefits at their own expense during the period of STD leave. Contact PHR Shared Services at 1-877-608-0044 for more information about STD leave, including how to continue paying for benefits at your own expense.

Compensation Continuance Program

Compensation Continuance (CC) is provided to all Partner Physicians at SCPMG expense. This benefit is taxable to you when received.

If you become disabled for 31 days or more, CC is payable for up to 22 weeks, provided you remain disabled.

The benefit payable is the greater of:

• 60% of your monthly Base Compensation (pro-rated to your work schedule), or

• 60% of your average monthly gross compensation (for the 12-month period ending December 31 or June 30) immediately preceding the onset of disability

The following Sick Leave benefits may be used in order to supplement this benefit:

• You may draw from your Accumulated Acute Sick Leave (AASL) in 40% increments, or

• You may draw from your Chronic Sick Leave (CSL) in 25% increments

Example 1: Partner Dr. Simes has 10 days of AASL, is temporarily disabled, and has satisfied the 30-calendar-day waiting period (22 work days) before commencing benefits from the Compensation Continuance Program. Dr. Simes will use 25 days of AASL (10 days in 40% increments) to supplement his payments from the Compensation Continuance Program. Benefits from AASL will be prorated to his current work schedule.

Note: If Dr. Simes is receiving Disability benefits or other Sick Leave benefits, his Sick Leave benefits will be limited when combined with the Compensation Continuance Program to ensure he does not receive greater than 100% of his Base Compensation or gross compensation.



Example 2: Partner Dr. Berman is temporarily disabled and has satisfied the 30-day waiting period. Dr. Berman has no AASL, therefore his Compensation Continuance payments will be supplemented with 25% pay from his Chronic Sick Leave bank.

Note: If Dr. Berman is receiving disability benefits or other Sick Leave benefits, his Sick Leave benefits will be limited when combined with the Compensation Continuance Program to ensure he does not receive greater than 100% of his Base Compensation or gross compensation.

The Compensation Continuance Program is a non-insured benefit administered by CIGNA. In order for benefits to be paid, you must submit proof of your disability to CIGNA. CIGNA will provide SCPMG with an Advice to Pay benefits allowance under the Compensation Continuance Program indicating how many days of Compensation Continuance benefits you will be eligible to receive. CIGNA and your attending physician or an independent medical examiner will make the determination of disability, not SCPMG. This ensures a high level of confidentiality for disabled physicians.

Partial Disability

If, after you have met the 30-day waiting period, you return to practice on a part-time basis, you may receive benefits from the Compensation Continuance Program and any applicable Sick Leave benefits for the days you do not work (in accordance with your last work schedule).

The reduced work schedule must be approved by your Chief of Service and your Area Medical Director.

Contact PHR Shared Services for more information about the Compensation Continuance Program at 1-877-608-0044.

Additional Information for Partner Physicians

The Board of Directors has the discretionary authority to convert a Partner’s Leave of Absence, Extended Educational Leave, or Medical Service Leave to Sick Leave in the event the Partner Physician becomes seriously disabled or is hospitalized.

Partner Physicians who have notified the Executive Medical Director and the Board of Directors of an intent to retire or terminate from the Partnership will be entitled to benefits under Acute Sick Leave, accrued Accumulated Acute Sick Leave, Chronic Sick Leave, and the Disability programs should they become ill or injured during the interim period prior to their retirement or termination.

A Partner Physician on Sick Leave or Disability is not eligible for Early Separation.

Contact PHR Shared Services for additional information at 1-877-608-0044.



LONG-TERM DISABILITY INSURANCE

Eligibility

All actively-at-work physicians, (excludes Per Diem Physicians), are eligible for Long-Term Disability (LTD) Insurance. Associate Physicians may enroll, at their own expense, within 60 days of hire without proof of insurability. There is no enrollment after 60 days of hire.

Partner Physicians are automatically enrolled at SCPMG expense upon election to Partnership. The coverage may not be declined.

The insurer is Life Insurance Company of North America, a CIGNA company.

The terms of the LTD Insurance plan are contained in a member certificate (also referred to as the insurance contract in this Handbook).

You can obtain a copy of the member certificate by contacting PHR Shared Services at 1-877-608-0044.

Benefits

The LTD benefit is equal to 50% of your monthly covered earnings. Covered earnings means the greater of:

• 50% of your monthly Base Compensation as of the onset of disability prorated to your work schedule at that time (including compensation increases during the first six months of disability), or

• 50% of your average monthly gross compensation for the 12 months ending the June 30 or December 31 immediately preceding the onset of disability

Gross compensation means your monthly Base Compensation plus overnight and extra duty pay, but excludes amounts received as bonuses, awards, Imputed Income, or Year-End Performance Draw.

The maximum amount of monthly covered earnings is $40,000, for a maximum LTD benefit of $20,000 per month. The minimum LTD benefit is $100 per month. The LTD benefit may also be subject to the limitations described later under Benefit Reductions.

During the benefit period, you may be required to provide periodic proof that you remain disabled. CIGNA may reasonably require that you have an examination at any time you are claiming benefits.

Benefit Waiting Period

The benefit waiting period is the period of time you must be continuously disabled before LTD benefits can begin. Your benefit waiting period is six months, during which time you may be eligible to receive SCPMG Sick Leave pay and Compensation Continuance or STD insurance benefits as applicable.



Maximum Benefit Period

LTD benefits will be paid on a monthly basis and will continue as long as you remain disabled in accordance with the following schedule:

Age When Disability Begins Maximum Benefit Period

62 or younger Your 65th birthday or 42 monthly payments, if later

63 36 monthly payments






69 or older 12 monthly payments

When Benefits End

LTD benefits will end on the earliest of:

• the date you earn more than 80% of your Indexed Covered Earnings

• the date CIGNA determines you are not disabled

• the end of the maximum benefit period



You will be considered disabled if, because of a covered injury or sickness, you are unable to perform all the material duties of your regular occupation, or solely due to injury or sickness, you are unable to earn 80% or more of your covered earnings.

Benefit Reductions

If, for any reason, your LTD benefit, plus any other income benefits (defined below), exceeds 60% of your monthly covered earnings, the LTD benefit will be reduced to bring the total to no more than 60%. (There is no reduction of this benefit if you are also collecting payments from an individual, privately purchased policy.)



Other Income Benefits

A few examples of other income benefits include, but are not limited to, the following:

• any amounts you or your dependents receive under the Canada and Quebec Pension plans; the Railroad Retirement Act; any local, state, provincial or federal government disability or retirement plan or law; 50% of any Accumulated Acute Sick Leave (AASL) and Chronic Sick Leave (CSL), provided they do not exceed 25% of your monthly Base Compensation; any work loss provision in mandatory no-fault auto insurance; any Workers’ Compensation, occupational disease, unemployment compensation law or similar state or federal law, including all permanent and temporary disability benefits

• any Social Security disability benefits you or a third party receive for yourself or your dependents because of your entitlement to the Social Security benefit

• any SCPMG-funded retirement plan benefits, (excludes the Common Plan)

• any proceeds payable under any franchise or group insurance or similar plan

• any wage or salary for work performed, but only to the extent provided for under the Work Incentive Benefit section. Refer to your certificate for further details

Pre-Existing Condition Limitation

If your LTD insurance has been in effect for less than 12 months, no benefits are paid as a result of a pre-existing condition. A pre-existing condition means any injury or sickness for which you incurred expenses; received medical treatment, care, or services; including diagnostic measures; received prescription drugs or medicines; or consulted with a physician within three months of your coverage start date.

Benefit Limit for Mental Illness and Substance Abuse

LTD benefits are limited for a disability caused or contributed to by a mental illness or substance abuse. The plan provides coverage up to a lifetime maximum of 24 monthly payments. Once the 24 monthly payments have been made, no further benefits will be payable for any of the following conditions:

Please note this list may change from time to time so refer to the member certificate for the most current list.

• alcoholism

• anxiety disorders

• delusional (paranoid) disorders



• depressive disorders

• drug addiction or abuse

• eating disorders

• mental illness (bipolar affective disorder, psychotic disease, and schizophrenia will be paid for the duration of the disability or to age 65, whichever occurs first)

• somatoform disorders (psychosomatic illness)

If you are confined in a hospital for more than 14 consecutive days for one of the conditions listed above, the confinement will not count toward the lifetime maximum. However, the hospital confinement must occur before you reach the lifetime maximum benefit limit.

Work Incentive Benefit

If you are able to return to work for either SCPMG or another employer while disabled, you may continue to receive LTD benefits—known as a work incentive benefit—during a period of partial disability. Any reduced work schedule must be approved by your Chief of Service and the Area Medical Director.

However, your LTD benefits could be reduced as described below.

For the first 24 months you return to work:

For the first 24 months the Physician returns to work, the Disability Benefit is as figured above. If for any month during this period, the sum of the Physician’s Disability Benefit, current earnings and any additional Other Income Benefits exceeds 100% of his or her Indexed Covered Earnings, the Disability Benefit will be reduced by the excess amount.

After the first 24 months:

After the first 24 months, the Physician’s Disability Benefit is as figured above, reduced by 50% of his or her current earnings received during any month he or she returns to work. If the sum of the Physician’s Disability Benefit, current earnings and any additional Other Income Benefits exceeds 80% of his or her monthly Indexed Covered Earnings, the Disability Benefit will be reduced by the excess amount.

In addition, if only a percentage of a Physician’s pre-disability income was covered by this Long-Term Disability Policy, then a percentage multiplier will be used in calculating return to work earnings after the first 24 months.



Income Maintenance Benefit (Progressive Illness Enhancement)

You may qualify for this enhancement if you are diagnosed with a slowly debilitating medical condition that forces you to reduce your work schedule and ultimately stop working. If a LTD claim is filed due to the disabling condition, the Progressive Illness enhancement allows the monthly LTD benefit to be calculated using your income at the time of diagnosis, not your base annual compensation when you stop working.

Current Earnings

Included in current earnings are any wage, vacation pay, acute sick leave pay or salary the Employee or Physician earns for work performed (including earnings from self-employment) while Disability Benefits are payable.

If the Employee or Physician is working for another employer on a regular basis when Disability begins, current earnings will include any increase in the amount he or she earns from this work during the period for which Disability Benefits are payable.

Rehabilitation Program

You may qualify to participate in the rehabilitation program if the insurance company determines that you are a suitable candidate for rehabilitation. Through this program, the insurance company will provide, arrange, and authorize vocational or physical rehabilitation services for you. While you participate in the program, you could receive payment of your:

• medical expenses


• moving expenses

• accommodation expenses

• family care expenses

Reasonable Accommodation Benefit under LTD Plan

If you are a disabled Associate Physician, SCPMG may provide reasonable accommodation so that you are able to return to work. A reasonable accommodation is any modification or adjustment to a job, an employment practice, or the work environment that makes it possible for a disabled person to perform the material duties of any occupation without causing undue hardship on SCPMG. SCPMG may receive reimbursement from any expenses incurred in providing the reasonable accommodation if the following conditions are met:

• the accommodation is made on your behalf and results in your ability to return to any occupation with SCPMG

• the accommodation is approved in writing by the insurance company before it is implemented or any expense incurred

• the accommodation meets the federal standards of a reasonable accommodation as detailed in the Americans With Disabilities Act of 1990, as amended



Spousal/Registered Domestic Partner Rehabilitation Program

At CIGNA’s determination, your spouse/domestic partner may qualify to participate in a rehabilitation program if the following conditions are met:

• you must be continuously disabled for 12 months,

• your spouse/domestic partner earns less than 60% of your covered earnings, and

• your spouse/domestic partner is determined to be a suitable candidate for rehabilitation

Your spouse must be your lawful spouse living with you on the date your disability begins. Your domestic partner must be a person who is registered as your domestic partner with the California Secretary of State or who has a current domestic partner affidavit on file with SCPMG. The rehabilitation program will end if your spouse/domestic partner is not living with you during the term of the program.

The LTD benefit will be reduced by 50% of your spouse/domestic partner’s earnings from rehabilitative work. If your spouse/domestic partner was working before the rehabilitation program begins, the LTD benefit will be reduced by 50% of the increase in income that results from your spouse/domestic partner’s participation in the program.

Your spousal/domestic partner rehabilitation program could include payment of your spouse/domestic partner’s:


• reasonable job placement expenses

• moving expenses

• family care expenses, if necessary for your spouse/domestic partner to be retrained under the program

Survivor Benefit

If you received at least six months of LTD benefits prior to your death, your survivor will receive a lump sum payment equal to six monthly benefit payments plus any current earnings by which your last LTD monthly benefit was reduced.

Under LTD insurance, survivor means your lawful spouse or domestic partner. If you do not have a spouse or domestic partner at the time of your death, benefits will be paid to your unmarried children under age 21 who are dependent on you for support and maintenance.



Exclusions

LTD benefits are not payable for a disability that results, directly or indirectly, from:

• suicide, attempted suicide, or intentionally self-inflicted injuries

• war or any act of war, whether declared or undeclared

• serving on full-time active duty in any armed forces

• terrorism or active participation in a riot

• commission of a felony

• revocation, restriction, or non-renewal of your license, permit, or certification necessary to perform the duties of your occupation

• any period of disability during which you are incarcerated in a penal or correctional institution

Termination of Insurance

Your LTD insurance coverage terminates on the date any of the following situations occur:

• you are no longer in active service

• you do not pay the premiums required for coverage

• you no longer qualify for coverage or

• the policy is terminated

During an approved unpaid leave of absence, LTD insurance coverage can continue for up to 12 months if you pay the required premiums.

Waiver of Premium

For Associate Physicians, if you leave work due to a certified disability, premiums will continue to be due until your Disability benefit is approved and payment begins. After that time, premium payment is waived while benefits are payable.

For Partner Physicians, the waiver of premium provision begins after you have been approved to receive a disability benefit and payment begins. The waiver of premium will continue while benefits are payable. You will save additional taxes due on the premium amount (Imputed Income) since SCPMG is no longer required to pay the premiums.

No Conversion




Claims

PHR Shared Services or CIGNA can assist you in filing your claim. Prompt response to PHR Shared Services and/or CIGNA will help ensure timely payment of your disability benefits.

Cost

For Associate Physicians, premiums are paid by the physician. For Partner Physicians, premiums are paid by SCPMG.

Tax Implications

Benefits received are not taxable for either the Associate or Partner Physician. Associate Physicians will pay for coverage on a post-tax basis through payroll deductions. For Partner Physicians, the value of this benefit is considered Imputed Income (unless the waiver of premium provision is in effect) and appears as taxable income on the annual SCPMG Statement of Partner Earnings.

Continuation of Other Benefits While on LTD

Medical (including KFHP coverage) and dental benefits may be continued until your termination from SCPMG.

For Partner Physicians, SCPMG will continue these benefits until the end of the month of your termination from the Partnership.

For Associate Physicians, SCPMG will continue these benefits for three months after you have exhausted your earned Sick Leave pay.

Part-time physicians may only continue KFHP coverage and are still responsible for 50% of the cost.

If you enrolled in Permanente Provided Life Insurance prior to your disability, you may be eligible for your life insurance to continue at the Medical Group’s expense while you are on a certified disability. You will also be eligible to continue your Optional Life Insurance at SCPMG’s expense while you are on a certified disability. Refer to the Life and Accident Insurance section of this Handbook for more information, or contact PHR Shared Services for additional information at 1-877-608-0044.

Your premiums for LTD coverage will be waived while you are receiving LTD benefits.



SUPPLEMENTAL INDIVIDUAL DISABILITY INSURANCE (Through UNUM)

Supplemental Individual Disability Insurance (SIDI) helps protect your earnings in the event that you experience a disabling illness or injury. This is a voluntary program. If you experience a covered disability and are disabled for 180 days or longer, SIDI will pay a non-taxable monthly benefit. When paired with group Long-Term Disability (LTD) coverage provided by SCPMG, SIDI can replace up to 65% of your income.

The terms of the SIDI benefit are contained in an insurance certificate, which is incorporated by reference in this Handbook. In the event of any contradictions or disputes as to the terms contained in this section and the insurance certificate, the insurance certificate will govern.

Eligibility

All active Partner and Associate Physicians age 70 and under (excludes Per Diem Physicians) are eligible to apply during defined enrollment periods. Physicians are notified prior to the start of an enrollment period. If you are eligible to apply, a personalized enrollment kit will be mailed to your home address. If you decide you want to apply for coverage outside of a defined enrollment period, you may submit an application with a full medical history statement, and coverage is subject to approval by the insurance company.

How the Benefit Works

If you currently have group Long-Term Disability coverage, you can purchase SIDI to help supplement your current group coverage. With SIDI, you will be able to cover a larger proportion of your insurable income, up to an additional $10,000 in monthly non-taxable benefits. In the event of a covered disability, SIDI will replace more of your income at a time when you cannot work and may be in most need of the benefit. For example, this supplemental insurance provides income replacement for earnings not currently covered under the group Long-Term Disability insurance. For purposes of the group LTD insurance, Gross Compensation means your Monthly Base plus premium pay (overnight and extra duties). It does not include amounts received as bonus, awards, Imputed Income or at-risk compensation.

Also, the group LTD insurance provides 50% income replacement up to a maximum of $40,000 of eligible monthly earnings with a maximum monthly benefit of $20,000.

If you are an Associate Physician who does not currently participate in group Long-Term Disability coverage, you will still be able to purchase Individual Disability Insurance to help ensure that you have some income protection if you become disabled.



Benefits

You will have a choice to elect SIDI coverage in two different amounts, basic or upgraded coverage. If enrolled in SIDI, Partner Physicians receive coverage for the greater of the prior year’s K-1 or Current Eligible Earnings, and Associate Physicians receive coverage for the greater of the prior year’s W-2 earnings or Current Eligible Earnings.

The basic coverage option is based on 50% of the maximum amount of benefit for which you are eligible to apply during the enrollment period.

The upgraded coverage option is based on 100% of the maximum amount of benefit for which you are eligible to apply during the enrollment period.

If you elect the basic coverage option during your initial enrollment, you may increase to the upgraded coverage option at any time with full medical underwriting.

Unum will never decrease your benefit amount if your income decreases. An annual process called Guaranteed Coverage Increase (GCI) will provide you with an opportunity to increase your benefit if your income increases. Your premium will increase accordingly.

As your SCPMG monthly base compensation increases, your SIDI benefit will automatically increase once per year on September 1. You will receive notification on an annual basis that your benefit and premium amount will increase. If you do not want the increase, you will be able to decline the additional coverage and your benefit amount will remain the same.

Some other features of the Unum Supplemental Individual Disability Insurance benefit include:

• Catastrophic coverage, which can replace 35% of your pre-disability earnings up to a maximum of $10,000 per month (not to exceed 100% income replacement) in the event of a more severe disability.

• A 25% discount on premiums, which are guaranteed not to increase before age 65

• No medical exam required for coverage if enrolled during a defined enrollment period

• Choice of maximum benefit or a reduced benefit

• The ability to keep your policy with the same rate and benefits if you change employers in the future



Elimination Period

The Elimination Period is the length of time that you must be disabled before you can start receiving benefit payments. Your Elimination Period is 180 days (same as the group LTD insurance).

Maximum Benefit Period

SIDI benefits will be paid on a monthly basis and will continue as long as you remain disabled in accordance with the following schedule:

Age at Disability Maximum Period of Payment – Unum IDI

Before age 64 To age 67

At age 64 but before age 65 36 months

At or after age 65 but before age 75

24 months

At or after age 75 12 months

When Benefits End

SIDI benefits will end on the earliest of:

• the date you earn more than 80% of your Pre-Disability Earnings (e.g. you return from leave working a partial schedule)

• the date UNUM determines you are not disabled,

• the end of the maximum benefit period, or



A Total Disability means that as a result of sickness or injury you are not able to perform with reasonable continuity the substantial and material acts necessary to perform your Usual Occupation in the usual and customary way; and you choose not to work at any occupation.

“Usual Occupation” is comprised of the substantial and material acts of the occupation which an individual is regularly performing at the time a disability begins. UNUM will make that determination at the time of any

disability. Additionally, any benefit payment eligibility would be determined in accordance with the provisions of the policy.

A Partial Disability benefit would be payable if you are not totally disabled but are unable to earn 80% or more of your pre-disability earnings as a result of sickness or injury. Benefits start to accrue on the first day of a partial disability following the 180 day Elimination Period.



Pre-Existing Condition Exclusion

The Unum Supplemental Individual Disability policy does not have a Pre- Existing Condition exclusion.

Benefit Limit for Mental Illness

Benefits for mental disorders will be payable for 24 months over the life of your policy, not to exceed the Maximum Benefit Periods for Disability.

Exclusions

Benefits will not be paid for a Disability caused by:

1. War or act of war, whether declared or undeclared

2. Intentionally self-inflicted injuries

3. Any Disability Unum has excluded by name or specific description (any such exclusion will appear on the Additional Exclusions page of your policy)

4. Any loss to which a contributing cause was your commission of or intent to commit a felony or to which a contributing cause was your being engaged in an illegal occupation

Waiver of Premium

After 90 days of Disability resulting from injuries or sickness not excluded from coverage, Unum will:

1. Refund any premiums for your policy that were due and paid while you were disabled and

2. Waive the payment of premiums that thereafter become due for as long as the Disability continues, but not beyond the maximum benefit period

Claims

For assistance with filing a disability claim, contact PHR Shared Services for directions. You can also contact a UNUM representative at 1-888-226-7959. Prompt response to PHR Shared Services and/or Unum will help ensure timely payment of your Disability benefits.

Cost

Premiums are paid by the physician.

Tax Implications

Benefits received are not taxable as they are paid on a post-tax basis through payroll deductions.



SICK LEAVE AND DISABILITY BENEFITS TIMELINES

Partner Physicians

Your Sick Leave benefits (which are described in the Paid Time-Off section) and Disability programs are integrated to keep you in active Partner status for as long as possible. Partnership status may be active even if you are on a leave that is not paid. The timeline below depicts the range of time that these benefits continue from the first day of disability to the Partnership end date. The time available depends on your Sick Leave pay balances at the time you become disabled. This timeline assumes a Partner has a full bank of all Sick Leave pay benefits.

Month: 0 1 6 12 30 36 Termination

SCPMG Pay ASL 100% CC 60%, AASL 40% CSL 25%

Partnership Continues

ASL 100% AASL, CC 5 months

CSL 25% 6 months

CSL 0% 18 months

LWOP 6 months

Maximum 36 months

CIGNA Benefit

6-Month Waiting Period LTD 50%,* To Age 65 (or ADEA Schedule)

* Monthly benefit limited to $20,000/month.

Glossary of Terms for All Tables

AASL: Accumulated Acute Sick Leave

ACSL: Accumulated Chronic Sick Leave

ADEA: Age Discrimination in Employment Act

ASL: Acute Sick Leave

CC: Compensation Continuance Program

CIGNA: Disability Insurance Carrier

CSL: Chronic Sick Leave

LTD: Long-Term Disability

LWOP: Leave Without Pay

STD: Short-Term Disability



Associate Physicians (Except Special Category)

Your Sick Leave and Disability programs are integrated to keep you on active status for as long as possible. Employment status may be active even if you are on a leave that is not paid. The timeline below depicts the range of time that these benefits continue from the first day of disability to the employment end date. The time available depends on your Acute Sick Leave balance at the time you become disabled. This timeline assumes the Associate Physician has a full bank of Acute Sick Leave.

Associate Physicians with a hire date prior to July 1, 2014:

Month: 0 1 4 Termination

SCPMG Pay ASL 100%

Employment Continues

ASL 100% LWOP 3 months Maximum 4 months

CIGNA Benefit

30-Day Waiting Period

STD 50%,* 5 months (22 weeks) LTD 50%,** (if purchased)To Age 65 (or ADEA Schedule)

* Weekly benefit limited to $3,462/week.** Monthly benefit limited to $15,000/month.

Associate Physicians with a hire date on or after July 1, 2014:

Month: 0 14 days 4 Termination

SCPMG Pay ASL 100%


ASL 100% LWOP 3 months Maximum 4 months

CIGNA Benefit


STD 50%,* 5.5 months (24 weeks) LTD 50%,** (if purchased)To Age 65 (or ADEA Schedule)




Special Category Physicians

Your Sick Leave and Disability programs are integrated to keep you on active status for as long as possible. Employment status may be active even if you are on a leave that is not paid. The timeline below depicts the range of time that these benefits continue from the first day of disability to the employment end date. This timeline assumes a special category physician has a full bank of Sick Leave benefits.

Special Category with a hire date prior to July 1, 2014:

Month: 0 14 days 4 Termination

SCPMG Pay ASL 100% ACSL 50% Maximum 3 months


ASL 100% ACSL Maximum 3 months LWOP 3 months Maximum 7 months

CIGNA Benefit


STD 50%,* 5 months LTD 50%,** (if purchased)To Age 65 (or ADEA Schedule)



LIFE, ACCIDENT AND OTHER INSURANCE BENEFITS

SECTION III

130

LIFE, ACCIDENT AND OTHER INSURANCE BENEFITS 131SECTION: III


LIFE AND ACCIDENT INSURANCE BENEFITS

SCPMG’s life and accident insurance programs provide financial protection for you and your beneficiaries in the event of your death or accidental loss of limb. The life and accident insurance program available to active physicians is made up of the following benefits:

• Permanente Provided Life Insurance, available to all physicians (excludes Per Diem Physicians)

• Optional Life Insurance, available to all physicians (excludes Per Diem Physicians)

• Disabled Physicians Life Insurance, available to all physicians (excludes Per Diem Physicians) enrolled in Permanente Provided and/or Optional Life Insurance who are disabled and receiving benefits under SCPMG’s Long-Term Disability Insurance coverage, or certified as disabled under separate agreement

• Spouse/Domestic Partner Life Insurance available to the spouses/ domestic partners of all physicians (excludes Per Diem Physicians), and

• Business Travel Accident Insurance, available to all physicians including Per Diem Physicians.

Life Insurance Company of North America, a CIGNA company, is the insurer under SCPMG’s life insurance policies. MetLife Life Insurance Company is the insurer under the Business Travel Accident insurance policy. The terms of these insurance benefits are contained in insurance certificates, which are incorporated by reference in this Handbook. In the event of any contradictions or disputes as to the terms summarized in this Handbook and the insurance certificates, the applicable insurance certificate will govern.

There are several terms used to describe your group life insurance program at SCPMG, such as:

• Actively At Work

• Credited Service

• Qualifying Service and

• Base Annual Compensation*

* For life insurance, base compensation excludes bonuses, awards and overtime. For a more precise definition, please refer to the CIGNA Life Insurance certificate.

You will find these terms and others described in the Glossary.

Additional life insurance benefits that may be available to you after your service with SCPMG ends are briefly described in the Leaving SCPMG section of this Handbook.



Combined Coverage Limitations

There are limitations on the total amount of insurance you can have from the combined SCPMG life insurance programs (not including Business Travel Accident Insurance and the Accidental Death and Dismemberment portion of Optional Life Insurance).

Please note: The combined total of the Permanente Provided and Optional Life Insurance cannot exceed 600% of Base Annual Compensation, with a combined dollar maximum of $2,500,000.

• The Permanente Provided Life Insurance coverage for physicians age 65 or older will continue at the normal multiple of Base Annual Compensation pro-rated to work schedule (100%, 200% or 300% based on physician service) until the Partner Physician terminates from the Partnership or the Associate Physician terminates employment with SCMPG.

• The Optional Life Insurance coverage for physicians age 65 or older will continue at the normal multiple of Base Annual Compensation pro-rated to work schedule (100%, 200%, 300%, 400%, 500%, or 600%) until the Partner Physician terminates from the Partnership, or the Associate Physician terminates employment with SCPMG.

Whenever your total amount of insurance exceeds the dollar limit, the Optional Life Insurance amount will be reduced to keep your coverage within these maximums. Over time, as your Permanente Provided coverage increases, your Optional Life coverage may decrease. Consequently, any amount you pay in premiums may be reduced.

PERMANENTE PROVIDED LIFE INSURANCE

The insurer is Life Insurance Company of North America, a CIGNA company. An overview of the Permanente Provided Life Insurance coverage is described below.

The terms of the Permanente Provided Life Insurance benefit are contained in an insurance certificate, which is incorporated by reference in this Handbook. In the event of any contradictions or disputes as to the terms contained in this section and the insurance certificate, the insurance certificate will govern.

Refer to the group insurance certificate for this coverage for more details. You may obtain a copy of this certificate by contacting PHR Shared Services at 1-877-608-0044.

Eligibility

All active physicians (excludes Per Diem Physicians) are eligible for this insurance.



Enrollment

No enrollment is necessary. We will notify you when you become eligible that your coverage is about to begin. The insurance is automatically effective, unless you decline it in writing or you are not actively at work on the effective date. If you decline and subsequently wish to enroll, you will have to provide proof of insurability.

Effective Date

This insurance becomes effective once you meet the years of service criteria as outlined below, provided you are actively at work.

Coverage Amount

The coverage amount provided depends on your years of service as shown on the schedule below, your Base Annual Compensation, and your work schedule. For example, if you have eight years of credited service and Base Annual Compensation of $180,000, you will have $360,000 of this insurance. However, if you work a reduced schedule, the coverage is reduced. For example, an 8/10 schedule physician would have a coverage amount of $288,000 ($360,000 x .8).

Years of Service % of Base Annual Compensation

Less than 3 years of qualifying service 0%

3 years of qualifying service but less than 5 years of credited service 100%

5 years but less than 15 years of credited service 200%

15 or more years of credited service 300%

Your Permanente Provided Life Insurance—combined with any other SCPMG life insurance coverage you may elect (excluding Business Travel Accident Insurance and the Accidental Death and Dismemberment portion of Optional Life Insurance and Spousal Life Insurance)—cannot exceed a maximum of $2,500,000.

There are no additional benefits paid under this policy for accidental death or injury, although a terminal illness benefit may be available to you if you are terminally ill. Refer to the Important Information About Your Life Insurance coverage section for more information.



Exception to Work Schedule Proration

If you are working a reduced schedule due to partial disability, or you are age 55 or older and you work a reduced schedule, you may maintain your level of coverage in effect prior to the reduction in your work schedule by continuing to pay the full premium. Contact PHR Shared Services at 1-877-608-0044 for more information.

Naming a Beneficiary

You may name anyone you wish as beneficiary and may change your beneficiary at any time without the consent of the beneficiary, provided you have not irrevocably assigned your ownership interest. Refer to the life insurance coverage at the end of this section.

You must complete a separate beneficiary designation for each life insurance contract and retirement plan in which you participate or have a benefit. In the absence of a valid beneficiary designation, the default beneficiary provision of the applicable plan or contract will determine who will receive your benefit and how it will be paid.

If no beneficiary is named or surviving upon your death, your Permanente Provided Life Insurance will be paid to the first beneficiary listed below who is living at the time of your death: 1) your spouse/domestic partner, 2) your children, in equal shares, 3) your parents, in equal shares 4) your siblings, in equal shares, or 5) the executor or administrator of your estate as determined by the insurance company in accordance with state law.

To update, review or add your beneficiaries, log into the SCPMG Physician Portal at scpmgphysician.kp.org or contact PHR Shared Services at 1-877-608-0044.

Coverage After Age 65

The Permanente Provided Life Insurance coverage for physicians age 65 or older will continue at the normal multiple Base Annual Compensation (100% to 300% based on years of service) until the Partner Physician terminates from the Partnership or the Associate Physician terminates employment with SCPMG.

When Coverage Ends

Refer to the life insurance coverage at the end of this section.

Cost

SCPMG pays the full cost of Permanente Provided Life Insurance.

If you are a Partner Physician, the premiums paid on your behalf are considered Imputed Income and appear as taxable income on your annual SCPMG Statement of Partner Earnings.

If you are an Associate Physician, the premiums for the portion of all life insurance benefits in excess of $50,000 are considered Imputed Income. Premiums attributable to that portion of the insurance will appear as taxable income on your Form W-2 and you will see this amount monthly on your paycheck stub.



OPTIONAL LIFE INSURANCE

The insurer is Life Insurance Company of North America, a CIGNA company. An overview of the Optional Life Insurance coverage is described below.

The terms of the Optional Life Insurance benefit are contained in an insurance certificate, which is incorporated by reference in this Handbook. In the event of any contradictions or disputes as to the terms contained in this section and the insurance certificate, the insurance certificate will govern.


Eligibility

All active physicians (excludes Per Diem Physicians) are eligible for this insurance.

Enrollment

Optional Life Insurance is offered during the 60-day period following either your date of hire or your election to Partnership. If the insurance is elected during either of these 60-day periods, coverage up to a maximum of 200% of your Base Annual Compensation can be issued upon application. Within 60 days after a life status change (marriage, birth, etc.), you may increase your optional life insurance coverage amount by one benefit level up to 200%. Any amount over 200% of your Base Annual Compensation or $2,500,000 (whichever is less) is subject to evidence of insurability satisfactory to the insurance company. Your insurance coverage will not become initially effective before the date you are actively at work. Your Local and Regional Permanente Human Resources Offices have the necessary forms.

Optional Life Insurance requested at any time other than the 60-day eligibility period is subject to evidence of insurability with no guaranteed minimum coverage.

Effective Date

The guaranteed portion (up to 200% of your Base Annual Compensation) of this insurance, pro-rated to work schedule, is effective on the date of enrollment provided you are actively at work. If you are not actively at work, your coverage will become effective on the first day you return to active service with SCPMG. Any amount in excess of 200% or applications outside the 60-day eligibility period are generally subject to evidence of insurability and become effective on the date approved in writing by the insurance company. However, you may increase your optional life insurance coverage amount within 60 days after a life status change by one benefit level up to the Guaranteed Issue Amount, without satisfying an insurability requirement.



Refer to the Important Information About Your Life Insurance coverage section for more information.

Benefit Amount

You may elect to purchase a benefit of 100%, 200%, 300%, 400%, 500%, or 600% of your Base Annual Compensation, prorated to your work schedule; however, there are limitations on the total amount of insurance you can have from the combined SCPMG life insurance programs. Refer to the Combined Coverage Limitations at the beginning of this section for more information. A terminal illness benefit may be available to you if you are terminally ill. Refer to the group insurance certificate or contact PHR Shared Services at 1-877-608-0044 for more information.

Exception to Work Schedule Proration

If you are working a reduced schedule due to partial disability, or you are age 55 or older and you work a reduced schedule, you may maintain your level of coverage in effect prior to the reduction in your work schedule by continuing to pay the full premium. Contact PHR Shared Services at 1-877-608-0044 for more information.

Death Due to Any Cause—Suicide Limitation

This benefit will be paid to your beneficiary upon your death due to any cause; however, payment will not be made for death due to suicide during the first two years of coverage. This limitation also applies to any additional or increases in benefits.


You may name anyone you wish as your beneficiary and change your beneficiary at any time without the consent of the beneficiary, provided you have not irrevocably assigned your ownership interest. Refer to the life insurance coverage at the end of this section.




If no beneficiary is named or surviving upon your death, your Optional Life Insurance will be paid to the first beneficiary listed below who is living at the time of your death: 1) your spouse/domestic partner, 2) your children, in equal shares, 3) your parents, in equal shares, 4) your siblings, in equal shares, or 5) the executor or administrator of your estate as determined by the insurance company in accordance with state law.


Coverage After Age 65

If you continue to work (excludes Per Diem Physicians) after the month you reach age 65, you may choose to do one of the following:

You may continue to purchase Optional Life Insurance. If you do not request to discontinue it in writing, the premiums will automatically continue to be deducted from your paychecks, or

If you have met the eligibility requirements for Tapered Life Insurance, you may request a transfer to the Tapered Life Insurance program for which you are eligible. Refer to the Leaving SCPMG section for more detailed information.

When Coverage Ends

Refer to the life insurance coverage at the end of this section.

Accidental Death and Dismemberment

A general overview of Accidental Death and Dismemberment coverage is described below. Refer to the insurance certificate for more information.

• 100% of insurance amount, up to a maximum of $200,000, for loss of:

– life

– two or more losses (hand, foot, or entire sight of one eye as defined below)

– loss of speech and hearing (in both ears)

– quadriplegia

• 75% of the insurance amount

– paraplegia

• 50% of insurance amount, up to a maximum of $100,000, for loss of:

– hand at or above the wrist

– foot at or above the ankle

– entire sight of one eye



– hemiplegia

– severance and reattachment of one hand or foot

– loss of speech

– loss of hearing (in both ears)

• 25% of insurance amount, up to a maximum of $50,000, for loss of thumb and index finger of the same hand

– uniplegia

– loss of all four fingers of the same hand

• 20% of insurance amount

– loss of all the toes of the same foot

• 1% of the insurance amount for coma, payable for 11 months, at the end of each month during which the covered person remains comatose

– lump sum 100% of the insurance amount beginning of the 12th month

Under this coverage, the loss of a hand or foot means the complete severance through or above the wrist or ankle joint. Loss of sight means the total, permanent and irrecoverable loss of sight of the eye. Loss of a thumb and index finger means the complete severance through or above the metacarpophalangeal joints.

Provided you have not irrevocably assigned your ownership interest, accidental death benefits will be paid to the beneficiary designated on your Optional Life Insurance beneficiary form. Payment for accidental dismemberment losses will be made to you. If you have irrevocably assigned your ownership interest, payment will be made to the owner of your insurance benefit. Accidental Death and Dismemberment benefits are in addition to the $2,500,000 aggregate limit on life insurance from SCPMG.

Accidental Death and Dismemberment benefits are not payable for certain losses, including but not limited to losses, resulting from:

• suicide, attempted suicide or intentionally self-inflicted injury

• sickness, disease or bodily infirmity; medical or surgical treatment; or bacterial or viral infection no matter how contracted. This does not include bacterial infection that is the result of an accidental bodily injury or food poisoning

• full-time active duty in any armed forces for more than 30 days. Reserve or National Guard active duty or training are not excluded unless it extends beyond 31 days

• commission of a felony or an assault

• voluntary self-administration of any drug or chemical substance not prescribed by and taken according to a doctor’s direction. Accidental ingestion of a poisonous substance is not excluded.



• war or any act of war, whether or not declared, or

• travel or flight in or getting in or out of:

– an aircraft being used for a test or experiment

– a military aircraft, unless it is operated by the U.S. Military Airlift Command (MAC) or its foreign equivalent

– an aircraft the physician is flying or learning to fly

– a pilot or crew member in any aircraft

– an aircraft owned or leased by or for SCPMG, the physician or the physician’s family

– an aircraft that is not flown by a pilot with a valid license or

– an aircraft that does not have a valid FAA normal or transport type certificate of airworthiness

Refer to policy for full listing of exclusions.

Cost

Optional Life Insurance premiums are based on your age. Ages are grouped as follows:

Under age 20 50 – 54

20 – 24 55 – 59

25 – 29 60 – 64

30 – 34 65 – 69

35 – 39 70 – 74

40 – 44 75 – 79

45 – 49 80 and over

These age groups are subject to change from time-to-time. For the most current rates and age groups, contact PHR Shared Services at 1-877-608-0044.

When you reach a new age group, or your compensation or work schedule increases, your monthly premiums are automatically increased. Premium rates are subject to change after the guarantee period. You may obtain the current rates from your local Permanente Human Resources department or from PHR Shared Services at 1-877-608-0044.

Physicians who were enrolled in the Group Rated Optional Life Insurance program prior to January 1, 1996, and did not elect the age-rated life plan, have their premiums based on a composite (group) rate, as opposed to rates based on age. Contact PHR Shared Services at 1-877-608-0044 if you have any questions.



Imputed Income

Although Associate Physicians pay the premium for this insurance, you may still be required to pay Imputed Income tax on a portion of the total premium amount. If the total of premiums paid for all SCPMG life insurance is lower than the IRS tables require, the difference results in Imputed Income on the Associate Physician’s Form W-2. You will see this amount reported on your paycheck.

DISABLED PHYSICIANS LIFE INSURANCE

The insurer is Life Insurance Company of North America, a CIGNA company. An overview of the Permanente Disabled Physicians Life Insurance coverage is described below.

The terms of the Permanente Disabled Physicians Life Insurance benefit are contained in an insurance certificate (sometimes referred to as the insurance contract in this Handbook), which is incorporated by reference in this Handbook.


Eligibility

Disabled Physicians Life Insurance is available to all eligible Partner and Associate Physicians (excludes Per Diem Physicians), with Permanente Provided and/or Optional Life Insurance, who are disabled for six months or longer and are receiving benefits under SCPMG’s Long-Term Disability Insurance coverage provided by the Life Insurance Company of North America or who are medically certified under NHD986030. Refer to the group insurance certificate or contact PHR Shared Services at 1-877-608-0044 for more information about what it means to be Disabled for the purposes of this coverage.

Enrollment

There is no enrollment for this coverage. Your Permanente Provided and/or Optional Life Insurance will become Disabled Physicians Life Insurance once you meet the eligibility criteria described above.

Effective Date

Your Disabled Physicians Life Insurance will be effective on the date you meet the eligibility criteria described above.



Benefit Amount

Your benefit amount will be equal to the amount of Permanente Provided and/or Optional Life Insurance coverage you had on the date you meet the eligibility criteria described above; however, there are limitations on the total amount of insurance you can have from the combined SCPMG life insurance programs. Refer to the Combined Coverage Limitations at the beginning of this section for more information. If you change physician benefit classes while insured under Disabled Physicians Life Insurance, your coverage will be adjusted, effective as of the date of your physician benefit class change (except your coverage will end if you change to per diem status). A terminal illness benefit may be available to you if you are terminally ill. Refer to the life insurance coverage section for more information.


The beneficiary or beneficiaries you selected for your Permanente Provided Life and/or Optional Life Insurance coverage will remain your beneficiary or beneficiaries for your Disabled Physicians Life Insurance coverage.

You may name anyone you wish as your beneficiary and change your beneficiary at any time without the consent of the beneficiary, provided you have not irrevocably assigned your ownership interest. (Refer to the life insurance coverage section for more information.)


If no beneficiary is named or surviving upon your death, your Disabled Physicians Life Insurance will be paid to the first beneficiary listed below who is living at the time of your death: 1) your spouse/domestic partner 2) your children, in equal shares 3) your parents, in equal shares 4) your siblings, in equal shares or 5) the executor or administrator of your estate as determined by the insurance company in accordance with state law.


Premiums While Disabled

You will pay no premiums for your Disabled Physicians Life Insurance coverage. When you are no longer considered disabled, and you have returned to active service with SCPMG, your Disabled Physicians Life Insurance coverage will revert to Permanente Provided and/or Optional Life Insurance coverage, and you will again pay premiums for any Optional



Life Insurance coverage you maintain. You will be subject to tax on Imputed Income as described below.

When Coverage Ends

Your coverage under Disabled Physicians Life Insurance ends when you are no longer Disabled or when you reach age 65, whichever comes first. Refer to the life insurance coverage for more information.

Imputed Income

If you are a Partner Physician, the premiums paid on your behalf are considered Imputed Income and appear as taxable income on your annual SCPMG Statement of Partner Earnings.

If you are an Associate Physician, the premiums for the portion of all life insurance benefits in excess of $50,000 are considered Imputed Income. Premiums attributable to that portion of the insurance will appear as taxable income on your Form W-2, and you will see this amount monthly on your paycheck stub.

SPOUSE/DOMESTIC PARTNER LIFE INSURANCE

The insurer is Life Insurance Company of North America, a CIGNA company. An overview of the Permanente Spouse/Domestic Partner Life Insurance coverage is described below.

The terms of the Permanente Spouse/Domestic Partner Life Insurance benefit are contained in an insurance certificate (sometimes referred to as the insurance contract, which is incorporated by reference in this Handbook).

Refer to the group insurance certificate for this coverage for more information. You may obtain a copy of this certificate by contacting PHR Shared Services at 1-877-608-0044.

Eligibility

Spouses or domestic partners of all eligible Partner and Associate Physicians (excludes Per Diem Physicians) are eligible for this insurance. Your spouse



must be your lawful spouse and not legally separated, divorced, or widowed from you. A domestic partner for the purposes of this insurance coverage means a person who has a current Domestic Partner Affidavit on file with SCPMG.

Enrollment

You must elect coverage for your spouse/domestic partner within 60 days after you become a member of an eligible physician class, within 60 days of a life status change, or within 60 days of your election to Partner Physician status. Elections for coverage more than 60 days after one of these events will be subject to evidence of insurability.

Effective Date

Spouse/Domestic Partner Life Insurance coverage is effective on the latest to occur of:

• The date SCPMG receives your completed enrollment request

• The date you authorize payroll deduction for this coverage

• The date you are actively at work or

• The date SCPMG and CIGNA agree in writing to provide this coverage

Benefit Amount

You may elect to purchase a benefit in $50,000 increments from $50,000 up to a maximum of $500,000. A benefit amount in excess of $100,000 will be subject to evidence of insurability. If you elect coverage for your spouse/ domestic partner more than 60 days after one of the events described above under the Enrollment heading, your spouse/domestic partner will be subject to evidence of insurability. Spouse/Domestic Partner Life Insurance coverage is not subject to SCPMG combined coverage limitations. A terminal illness benefit may be available to if your spouse/domestic partner is terminally ill. Refer to the life insurance coverage section for more information.

Death Due to Any Cause—Suicide Limitation

This benefit will be paid to your spouse/domestic partner’s beneficiary upon his/her death generally due to any cause; however, payment will not be made for death due to suicide during the first two years of coverage. This limitation also applies to any additional or increases in benefits.


Your spouse/domestic partner may name anyone as the beneficiary and change their beneficiary at any time without the consent of the beneficiary, provided he/she has not irrevocably assigned their ownership interest. (Refer



to the life insurance coverage section for more information.) The designation must be in writing. Once a change of beneficiary form is received by PHR Shared Services, it becomes effective the date your spouse/domestic partner signed the form.

If no beneficiary is named or surviving upon your spouse/domestic partner’s death, the insurance will be paid to the first beneficiary listed below who is living at the time of their death: 1) spouse/domestic partner, 2) spouse/ domestic partner’s children, 3) spouse/domestic partner’s parents, 4) spouse/ domestic partner’s siblings, or 5) spouse/domestic partner’s estate as determined by the insurance company in accordance with state law.

Please contact your local Permanente Human Resources department for a Beneficiary Designation form, or you can download a form from the SCPMG Physician Portal at scpmgphysician.kp.org.

When Coverage Ends

Refer to the life insurance coverage section for information regarding when your coverage ends.

Cost

Spouse/domestic partner life insurance premiums are based on your spouse/ domestic partner’s age. Ages are grouped as follows:

Under age 20 60 – 64

20 – 24 65 – 69

25 – 29 70 – 74

30 – 34 75 – 79

35 – 39 80 – 84

40 – 44 85 – 90

45 – 49 91 – 94

50 – 54 95 or older

55 – 59

When your spouse/domestic partner reaches a new age group, the monthly premiums are automatically increased. Premium rates are subject to change after the guaranteed period. You may obtain the current rates from your local Permanente Human Resources department or from PHR Shared Services at 1-877-608-0044.



LIFE INSURANCE COVERAGE

Terminal Illness Benefit Option

The SCPMG life insurance programs include a terminal illness benefit option that allows a portion of your insurance benefit to be paid to you (provided you have not irrevocably assigned your ownership interest—see below for more details on assignment of life insurance benefits) while you are still living rather than to your beneficiary after your death. With the exception of Business Travel Accident Insurance, this special option is available in all of the following SCPMG group life insurance programs:

• Permanente Provided Life Insurance

• Optional Life Insurance

• Disabled Physicians Life Insurance

• Spouse/Domestic Partner Life Insurance

The benefit is equal to 80% of the insurance amount in effect (combined total of all of the group life insurance you have through SCPMG) at the time the insurance company determines that you qualify for this option. The maximum terminal illness benefit payable is $750,000 ($50,000 for your spouse/domestic partner) and is payable only once in your lifetime. The remaining life insurance benefit will be paid to your beneficiary/certificate owner upon your death.

If you elect to use this option, you must provide satisfactory evidence that your life expectancy is 12 months or less. This evidence includes a written diagnosis and prognosis including supportive evidence satisfactory to CIGNA, including but not limited to radiological, histological, or laboratory reports by two doctors licensed to practice in the U.S. The insurance company may investigate further to verify your eligibility. In addition, any automatic increase in life insurance benefits will end when benefits are payable under this provision.

Assignment of Life Insurance Benefits

Assignment is the transfer of all incidents of ownership to another person or, in some instances, to a trust. This includes your right to name or change beneficiaries. Assignment is irrevocable except with the written agreement of the assigned owner, and the tax consequences vary for each individual based on his or her circumstances. The benefits of assignment of life



insurance for your particular situation should be discussed with an advisor who specializes in estate planning.

An assignment will apply to the following SCPMG group life insurance programs:

• Permanente Provided Life Insurance

• Optional Life Insurance

• Disabled Physicians Life Insurance

• Spouse/Domestic Partner Life Insurance

Your ability to make an assignment may be affected if you have a spouse. Contact CIGNA for details. Contact information for CIGNA may be found in the Claims, Appeals and Administrative Information section.

Payment of Benefits

Under the Permanente Provided and Optional Life Insurance programs, insurance proceeds are placed in an interest-bearing checking account in the name of the beneficiary. If there is more than one beneficiary, each one will receive a separate account. With this account, the beneficiary has immediate access to the insurance proceeds. The account earns interest from the day it is opened to the day of withdrawal, at money market rates.

There are no monthly service charges, no per-check charges, and no monthly maintenance charges associated with this account. Monthly statements are provided reporting all account activities. The account holder may name a beneficiary.

Termination

Provided you do not decline coverage, your Permanente Provided, Optional Life, Disabled Physicians Life, and Spouse/Domestic Partner Life Insurance remain in effect until the earliest of the following occurs:

• the end of the month for which premiums are not paid

• you or your spouse/domestic partner are no longer eligible for coverage

• the insurance policy terminates

• you retire

• you terminate your service or

• the date you or your spouse/domestic partner are eligible for coverage under a plan intended to replace this coverage

Conversion of Life Insurance

If your Permanente Provided Life, Optional Life, Disabled Physicians Life, or Spouse/Domestic Partner Life Insurance terminates for any reason other than non-payment of premiums, you may convert part or all of it to an individual policy at your own expense.



If insurance ends due to termination of the policy or it is no longer offered for your class of covered individuals, you must have been insured under the policy for at least three years in order to convert to an individual policy. In this case, the amount of conversion insurance will be the benefit in force under the policy prior to termination or $10,000, whichever is less.

You must apply for and pay the premium for your age and class of risk within 90 days after your termination date from SCPMG. Evidence of insurability will not be required.

If you die during the 90-day conversion period, your beneficiary will receive the insurance amount, whether or not you applied for conversion coverage.

Your spouse/domestic partner may also convert their Spouse/Domestic Partner Life Insurance coverage in the event of your termination or your divorce or legal separation. Refer to the group insurance certificate or contact PHR Shared Services at 1-877-608-0044 for more information about conversion options for Spouse/Domestic Partner Life Insurance coverage.

The conversion insurance may be a type of life insurance currently being offered for conversion by the insurance company at your age and in the amount requested. It may not be term insurance, and it may not be for an amount greater than the life insurance benefits in force under the policy. The individual policy will not provide accident, disability, or other benefits.

Portability of Life Insurance

Life Insurance Company of North America, a CIGNA company, will allow you to port some or all of your Permanente Provided Life, Optional Life, or Disabled Physicians Life. You may either convert your insurance to a whole life policy (as mentioned above) or port the term life policy. The portability policy will be issued without proof of medical insurability. This may be advantageous if you have a health condition that could make it difficult to obtain individual coverage elsewhere, although the cost may be higher than a private policy obtained on your own. The option to port all or a part of your life insurance extends to age 80 with a $500,000 insurance maximum above age 70.

A spouse/domestic partner will also have the opportunity to port some or all of Spouse/Domestic Partner Life Insurance in the event eligibility is lost because the insured physician’s employment terminates or in the event the spouse/domestic partner no longer qualifies as your spouse/domestic partner due to legal separation, divorce, or the physician’s death. A spouse/ domestic partner who continues coverage through portability will be issued a separate certificate of insurance by CIGNA. The portability option for Spouse/Domestic Partner Life extends to age 70. At age 70, the policy will terminate, and the insured will receive a notice with the option to convert the lost coverage.



Portability to Term Life Option

Contact PHR Shared Services at 1-877-608-0044 to request an Application for Continuation of Term Life Insurance (Portability) and premium rate sheet. Application must be made within 90 days from the date you lose coverage. If you wish to exercise your portability option, request, complete, and forward the application to: NEBCO, P.O. Box 152501, Irving, TX 75015. If you have any questions, you may contact NEBCO at 1-800-423-1282.

BUSINESS TRAVEL ACCIDENT INSURANCE

Business Travel Accident (BTA) insurance provides benefits if you die or are injured in an accident while traveling on official business for SCPMG. Your normal commuting to and from work is not included. The insurer is MetLife Life Insurance Company. The terms of the BTA insurance benefit are contained in an insurance certificate (sometimes referred to as the insurance contract), which is incorporated by reference into this Handbook.

Who is Eligible

This insurance is provided for all eligible physicians (excludes Per Diem Physicians).

When Coverage Begins

You are automatically covered by BTA insurance beginning on your date of hire. Kaiser Permanente pays the premiums for this benefit.

How Business Travel Accident Insurance Works

BTA insurance provides 24-hour protection and covers you for certain losses sustained while traveling anywhere in the world on company business. BTA insurance provides a death benefit equal to four times your annual salary, up to a maximum of $250,000. The minimum death benefit payable is $100,000.

The following chart shows the percentage of payable benefits for covered losses under the BTA insurance plan:

When This Occurs Percentage of Payable Benefits

Loss of life 100%



Loss of a hand 50%

Loss of a foot 50%

Loss of speech and hearing 100%

Brain damage 100%

Quadriplegia (paralysis of both arms and both legs) 100%

Loss of either one arm or one leg on either side of the body

75%

Paraplegia (paralysis of both legs) 50%

Loss of sight of one eye 50%

Loss of speech or hearing 50%

Paralysis of one arm or leg 25%

Loss of thumb and index finger of same hand 25%

Coma 1% per month beginning on the 7th day of the coma and for the duration of the coma, to a maximum of 60 months

Please note: There is an aggregate maximum of $5 million sustained by all insured persons under the group policy as a result of one covered accident. This means that the individual maximum benefit payable may be reduced if more than one covered employee suffers a loss as the result of the same accident.

In the event of dismemberment, the benefit is paid to you. In the case of your death, the benefit is paid to the beneficiary you designated for your SCPMG-sponsored life insurance, unless you have designated otherwise.

Covered travel begins at the actual start of a business trip, whether it is from your home, work, or other location requested by, authorized or consented to by SCPMG. It ends upon your return to your home or work location, whichever comes first. Covered travel does not include vacation, leaves of absence, or travel between your residence and your regular work location. Losses suffered while on personal travel during a business trip are covered if the personal travel is no longer than seven days, is more than 100 miles from your primary residence or regular work location, and the personal travel does not take place during vacation or leave of absence.

Coverage includes travel by airplane, automobile, bus, motorcycle, ship, or train.

Exclusions

As of April 2019, BTA insurance does not cover losses resulting directly or indirectly, wholly or partly, when caused or contributed to by the following:

• physical or mental illness or infirmity, or the diagnosis or treatment of such illness or infirmity



• suicide or attempted suicide

• intentionally self-inflicted injury

• committing or attempting to commit a felony

• use of any drug, medication, or sedative, unless it is used as prescribed by a physician or taken as directed

• use of alcohol in combination with any drug, medication, or sedative

• use of poison, gas or fumes

• infection, other than infection occurring in an external accidental wound or from accidental food poisoning

• participation in hazardous activities such as scuba diving, bungee jumping, skydiving, hang gliding, ballooning, drag racing, driving a car fitted for competitive racing, aerial hunting, aerial skiing or travel in an aircraft for the purpose of parachuting or otherwise exiting an aircraft while the aircraft is in flight except for the purpose of self-preservation

• service in the armed forces of any country or international authority, except the United States National Guard

• any nuclear reaction or release of nuclear energy; this includes the radioactive, toxic, explosive or other hazardous or contaminating properties of radioactive matter

• the emission, discharge, dispersal, release, or escape of any solid, liquid, or gaseous chemical or biological agent

• war, whether declared or undeclared; or act of war, insurrection, rebellion, riot or terrorist act

• any incident related to travel in an aircraft or device in the following manner:

– as a pilot, crew member, flight student, or while acting in any capacity other than as a passenger

– parachuting or otherwise exiting from such aircraft while the aircraft is in flight, except for the purpose of self-preservation

– in an aircraft that does not have a valid Certificate of Airworthiness; is not flown by a pilot with a valid license to operate that aircraft or which is owned, leased, controlled, or charted by the policyholder

– in a device used for testing or experimental purposes; by or for any military authority for military purposes; for travel or designed for travel beyond the earth’s atmosphere; or for crop dusting, spraying, seeding, fire-fighting, sky diving, hand-gliding, sky writing or aerial photography

– in a device used for pipeline or power line inspection, aerial photography or exploration, racing, endurance tests or stunt or acrobatic flying

– in a device used for any use which requires a special permit from the Federal Aviation Administration



Refer to the insurance certificate for the complete list of exclusions.

Exclusion for Intoxication

No benefits will be paid for any loss if the injured party is intoxicated at the time of the incident and is the operator of a vehicle or other device involved in the incident.

Intoxicated means that the injured person’s blood alcohol level met or exceeded the level that creates a legal presumption of intoxication under the laws of the jurisdiction in which the incident occurred.

When Coverage Ends

BTA insurance ends on your termination date from SCPMG.

No Conversion or Portability Benefit

You cannot convert this coverage to an individual policy.


PAID TIME-OFF BENEFITS

SECTION IV

152

PAID TIME-OFF BENEFITS 153SECTION: IV


PAID TIME-OFF BENEFITS

This section represents a summary of paid time-off benefits available to eligible Partners and Associate Physicians, including Sick Leave pay, Vacation Leave pay, Education Leave pay, Holiday pay, Compassionate Leave pay, and Jury Duty pay. The paid time-off benefits described in this section are not subject to ERISA. In the case of any omission or conflict in this Handbook, the SCPMG Partnership Agreement, SCPMG Rules and Regulations, the minutes of SCPMG Board of Directors and the minutes of the Medical Directors, as applicable, always govern. The current SCPMG Partnership Agreement and Rules and Regulations is available for viewing or download from the SCPMG Physician Portal at scpmgphysician.kp.org or you may contact PHR Shared Services for an up-to-date copy.

SICK LEAVE PROGRAMS

Sick Leave Benefits

Sick Leave pay is provided by SCPMG for all physician categories. The type and amounts of Sick Leave pay depends on your physician category and work schedule.

For Associate or Special Category Physicians with a hire date before July 1, 2014

You can use Sick Leave pay to cover brief illnesses lasting more than 30 days as a supplement to Short-Term Disability Insurance benefits

For Associate or Special Category Physicians with a hire date on or after July 1, 2014

You can use Sick Leave benefits to cover brief illnesses lasting more than 14 days as a supplement to Short-Term Disability Insurance benefits

For Partner Physicians

You can use Sick Leave benefits to cover brief illnesses lasting more than 30 days as a supplement to Compensation Continuance Program

The Sick Leave pay programs are described in the SCPMG Partnership Agreement and Rules and Regulations. A brief summary of these programs follows.

All benefits paid under the Sick Leave programs are taxable.



Acute Sick Leave

Acute Sick Leave (ASL) pay is available for all eligible Partner and Associate Physicians (excludes Per Diem Physicians). ASL pays 100% of Base Compensation. SCPMG ASL program is intended to comply with applicable paid sick leave entitlements required under California law and local ordinances.

For all Partner Physicians and any Associate Physicians with a start date prior to July 1, 2014:

During your first year of employment, you will earn a total of 22 days of ASL days at the rate of 0.85 days per pay period. On your Anniversary Date, any unused ASL balance is deleted and another 22 days are added to your ASL account. For physicians working less than 10/10 schedules, the number of days available is prorated to your work schedule in effect on your Anniversary Date.

If you are a former Kaiser Foundation Hospital resident, you will be “front-loaded” up to 22 days of ASL at the beginning of your first year, but you will not earn additional ASL days during your first year of service as an Associate Physician.

For Associate Physicians with a start date on or after July 1, 2014:

During your first year, you will accumulate a total of 10 days of ASL days at the rate of 6.15 days per pay period for the first 13 pay periods (six months) in which you are an Associate Physician.

On your Anniversary Date, any remaining ASL balance is deleted and 10 days are added to your ASL account. For physicians working less than 10/10 schedules, the number of days available is prorated to your work schedule in effect on your Anniversary Date.

If you are a former Kaiser Foundation Hospital resident, you will receive up to 10 days of ASL at the beginning of your first year, but you will not accrue additional ASL days during your first year of service as an Associate Physician.

Using Your Acute Sick Leave

Earned ASL may be used for either full or partial day absences. For example, if, due to an illness, you are only able to work 50% of your scheduled shift, then the remaining 50% of work missed will be compensated and deducted from your ASL balance.

For Partner Physicians only: You may work a reduced schedule with the recommendation of the Chief of Service and approval of your Area Medical Director for up to six weeks while recovering from an acute illness that persists for at least one week.



For Associate Physicians: In accordance with California’s kin care law, Associate Physicians may use up to one half of your annual Acute Sick Leave accrual for purposes other than your own medical condition. Subject to the requirements of California law, this includes the following:

Refer to applicable law or go online at dir.ca.gov/dlse for more information.

• Time off resulting from illness or for the diagnosis, care or treatment of an existing condition or preventative care of a qualified family member. Qualified family members are:

– child (defined as biological, adopted, or foster child, stepchild, legal ward, or a child to whom the employee stands in loco parentis and regardless of age or dependency status)

– parent (defined as biological, adoptive or foster parent, stepparent, or legal guardian of an employee or the employee’s spouse or registered domestic partner, or a person who stood in loco parentis when the employee was a minor child)

– spouse or registered domestic partner

– grandparent

– grandchild

– sibling

– any individual related by blood or affinity whose close association with the employee is equivalent of a family relationship

• Time off for an employee who is a victim of domestic violence, sexual assault or stalking to:

– obtain or attempt to obtain any relief, including, but not limited to, a temporary restraining order, restraining order, or other injunctive relief to help ensure the health, safety, or welfare of the victim or his/her child

– seek medical attention for injuries caused by domestic violence, sexual assault or stalking

– obtain services from a domestic violence shelter, program, or rape crisis center as a result of domestic violence, sexual assault or stalking

– obtain psychological counseling related to an experience of domestic violence, sexual assault or stalking

– participate in safety planning and to take other actions to increase safety from future domestic violence, sexual assault, or stalking, including temporary or permanent relocation



If you use less than your annual ASL during any one year, your Anniversary Date will be not be adjusted. If you exceed your annual ASL benefit in an Anniversary Year, your Anniversary Date will be adjusted on a day-by-day basis according to the rules for Leave of Absence. Contact PHR Shared Services for additional information at 1-877-608-0044.

If your ASL has been exhausted, you may be eligible for other forms of paid time off. Please review the Paid Time-Off Benefits section of this Handbook for other time-off benefits that may be available to you.

Accumulated Acute Sick Leave (For Partner Physicians Only)

Partner Physicians will have 20% of their unused Acute Sick Leave balance transferred to their Accumulated Acute Sick Leave (AASL) account on each Anniversary Date following their first year of Partnership. The maximum AASL account balance is 44 days. AASL may be used when you have exhausted your annual Acute Sick Leave account. Use of AASL will not affect your Anniversary Date. AASL can be re-accumulated.

You may draw from your AASL account in full- or partial-day increments of:

• 100% Base Compensation for a full day

• 40% of a day

• 25% of a day

as needed to supplement the Compensation Continuance and/or Long-Term Disability benefits, if applicable.

For example: Partner Dr. Lee has 10 days of AASL in her account. Once Dr. Lee has exhausted her Acute Sick Leave, Dr. Lee could draw from her AASL balance in any of the following combinations (the following list is not exhaustive):

• 10 days of AASL at 100% of Base Compensation,

• 25 days of AASL at 40% of Base Compensation (to supplement a claim under the Compensation Continuance Program), or

• 40 days of AASL at 25% of Base Compensation (to supplement a Long-Term Disability claim).

Chronic Sick Leave (For Partner Physicians Only)

In addition to Acute Sick Leave and Accumulated Acute Sick Leave, Partners are entitled to an amount of Chronic Sick Leave (CSL) is compensation during their entire period of Partnership as outlined below.

Upon attaining Partnership, 528 working days are available for use for a certified disability:

• continuation of your Partnership and 25% of monthly Base Compensation (prorated to your average work schedule) for 132 working days (six months) of CSL

• continuation of your Partnership without compensation for up to 396 working days (18 months) of CSL without compensation except for Year-End Performance Draw



For each day of CSL taken, your Anniversary Date will be adjusted by one working day.

Your Partnership and health care benefits are maintained while on CSL. You are also eligible for adjustments to your Base Compensation. Sick Leave, Vacation Leave, and Educational Leave will not accrue while on CSL. Once used, CSL cannot be replaced or re-accumulated.

Your CSL benefits will be based on a calculation of your average work schedule during your work history with SCPMG as of the end of the calendar year preceding your current CSL (excluding all unpaid Leaves of Absence). If your percentage of time worked is in excess of 95%, the CSL will be paid based on a 10/10 work schedule. If it is 95% or less, CSL will be paid based on the average work schedule. CSL is charged on a five-day work week regardless of the current work schedule.

You may be able to supplement benefits you receive under CSL with Compensation Continuance or Long-Term Disability Insurance benefits. The benefits you receive under the Sick Leave programs will be limited when combined with the Compensation Continuance Program. Under no circumstances will you be able to combine other Sick Leave benefits with the Compensation Continuance Program to receive greater than 100% of your Base Compensation or gross compensation. Refer to the Compensation Continuance Program in this section for more information. Refer to the Chronic Sick Leave section in the SCPMG Partnership Agreement and Rules and Regulations, or contact PHR Shared Services at 1-877-608-0044 for additional information about Chronic Sick Leave.

Accumulated Chronic Sick Leave (For Special Category Physicians Only)

Accumulated Chronic Sick Leave (ACSL) is available to Special Category Physicians only. ACSL is used in conjunction with the disability insurance benefit for these physicians. After your first year as a Special Category Physician, 100% of your unused Acute Sick Leave balance is transferred to your ACSL account.

The maximum benefit is 66 working days (three months) paid at 50% of Base Compensation (prorated to your average work schedule), limited to the days accumulated. Once 66 days of ACSL have been accumulated, no additional days will be added.

For each day of ACSL taken, your Anniversary Date will be adjusted by one work day.

The Sick Leave Programs and Short-Term Disability are integrated to provide special category physicians with the continuation of a portion of income when disabled. Refer to the Chronic Sick Leave section of the SCPMG Partnership Agreement and Rules and Regulations or contact PHR Shared Services at 1-877-608-0044 for additional information about Chronic Sick Leave.



VACATION LEAVE

Vacation Leave pay is a paid time-off benefit available to physicians to use when time off from work is needed. Vacation Leave pay is accrued in hours on a biweekly basis according to the schedules for Vacation Leave accrual provided below.

Vacation Leave Accrual

The accruals listed below are based on a 10/10 work week—all of the Vacation Leave hours are pro-rated according to your work schedule.

Partner and Special Category Physicians

* Benefits Anniversary Year Vacation Leave Days Bi-Weekly Hours

1 – 4 23 7.08

5 – 9 28 8.61

10 or more 33 10.15

Associate Physicians

* Benefits Anniversary Year Vacation Leave Days Bi-Weekly Hours

1 – 4 18 5.54

5 – 9 23 7.07

10 or more 28 8.61

* For purposes of your benefits anniversary years, your time as an Associate and Partner Physician is combined.

Accrual of Vacation Leave hours will be prorated for physicians working less than a 10/10 work schedule. You will see your accrued Vacation Leave hours balance reflected on your biweekly paycheck stub. Vacation Leave hours accruals are processed biweekly or 26 times per year.

Requests for time off using Vacation Leave pay should be scheduled in advance and approved by your Chief of Service. Ordinarily, Vacation Leave pay should be taken in the year following the Anniversary Year in which it is earned; however, you may use accrued Vacation pay Leave during your current Anniversary Year.



For Partner Physicians: Vacation Leave pay will not accrue for any physician who is off work and using Chronic Sick Leave, Extended Educational Leave, Extended Military Service Leave, Extended Medical Service Leave, or Military Leave.

For all Partner and Associate Physicians: Vacation Leave pay will not accrue for any physician who is on leave without pay (longer than 10 days). Special rules may apply for other military-related leaves.

Borrowing Vacation Leave Time

You are able to borrow Vacation Leave time before it has accrued or run a negative balance for Parenting Leave or an unforeseeable health emergency of your spouse, domestic partner, child or parent. Appropriate documentation will be required. You must first receive the approval of your Area Medical Director and the Permanente Human Resources department. If you have earned Sick Leave benefits available, you must first exhaust available Sick Leave pay before you may borrow Vacation Leave time.

If you have a negative Vacation Leave balance you will begin to “pay down” your negative balance at a rate of 100% of your bi-weekly accrual. If you have borrowed Vacation Leave and subsequently leave SCPMG, any used but unearned Vacation Leave must be repaid.

Physicians will receive compensation in lieu of Vacation Leave in the following circumstances:

• Excess Vacation Leave Cash Out Your Vacation Leave balance may accrue to a maximum of 90 working days as of your Anniversary Date. At the conclusion of each Anniversary Year, any accrued but unused Vacation Leave hours over 90 days will be “cashed out” and paid in the first paycheck following your Anniversary.

• Voluntary Vacation Leave Cash Out If you have accrued and have available 20 or more days of Vacation Leave, you may make an election during the annual Open Enrollment period (November of each calendar year) to cash out your Vacation Leave accruals that you will earn in the next calendar year. Your election for Vacation Leave cash-out, once made, is irrevocable. If you fail to request a cash-out for the following year’s accrued Vacation Leave hours during the Open Enrollment period, you have waived your ability to cash-out Vacation Leave until the next Open Enrollment period.

• Financial Hardship Vacation Leave Cash Out You may cash out Vacation Leave for a severe financial hardship due to an unforeseeable emergency such as an illness or accident, loss of property due to casualty, or other similar extraordinary circumstance beyond your control.



When applying for a financial hardship Vacation Leave cash-out, you are eligible only for the amount necessary to meet the expenses related to the hardship. Cash-out of Vacation Leave for financial hardship must be approved in advance by the physician’s Area Medical Director and the Executive Medical Director after receiving a recommendation from the Permanente Human Resources department. You must present supporting documentation when requesting a financial hardship Vacation Leave cash-out.

All Vacation Leave cash-outs will be reflected on the paycheck in the pay period following approval of your request.

Illness While on Vacation Leave

If you develop a serious illness or are hospitalized while using Vacation Leave, the Area Medical Director may approve the physician’s request to convert to Acute Sick Leave pay usage.

Vacation Leave Sharing Program

Vacation Leave hours may be donated to an individual or to a Shared Leave Bank(s). For the purposes of this policy, a qualified event is either a qualifying “medical condition” or a qualifying “major disaster.” A qualifying medical condition is defined as a life-threatening illness or catastrophic injury or illness that requires prolonged absence from work. The absence may be continuous, as in hospitalizations following surgery or an accident, or intermittent, as in periodic absences for chemotherapy or other procedures. A qualifying major disaster is defined as a) major disaster as declared by the U.S. President under Section 401 of the Stafford Act, 42 U.S.C. Section 5170, that warrants individual assistance or individual and public assistance from the federal government under that Act, or b) a major disaster or emergency as declared by the U.S. President pursuant to 5 U.S.C. Section 639.

Any actively working physician who has more than 5 days of accrued, unused Vacation Leave may voluntarily donate unused Vacation Leave hours in increments of one day (8 hours) and up to one week (5 days or 40 hours) per calendar year. Only that Vacation Leave hours in excess of 5 vacation days will be considered for donation. Donations for Vacation Leave are irrevocable.

Termination

If you are a Partner Physician and leave the Partnership, or an Associate Physician who terminates employment, all of your accrued but not taken Vacation Leave hours will be paid out at your Base Compensation rate at time of termination or resignation.



If you are a Partner Physician who retires at the end of the year in which you turn age 65, or who elects Early Separation or Early Retirement, your Vacation Leave accrued hours will be paid out at your Base Compensation rate at the time of your retirement. All payments will be included in that year’s Statement of Partner Earnings.

Former Kaiser Foundation Hospital (KFH) Residents

Former KFH residents may transfer up to 10 days of Vacation Leave to SCPMG upon hire as a full-time Associate Physician. In order to be eligible for this transfer, you must:

• join SCPMG within 90 days of termination from Kaiser Foundation Hospital

• elect to transfer the Vacation Leave prior to terminating from Kaiser Foundation Hospital

Vacation Leave hours will be credited to you at your new rate of pay as an Associate Physician. You may not take Vacation Leave hours under the SCPMG pay rate until you have completed one month of service with SCPMG.

ANNUAL EDUCATIONAL LEAVE

Eligibility

The Annual Educational Leave pay program is available to the following physician categories:

• Active Partners in Categories I, II, and III (inactive Partners are ineligible)

• Full-Time Regular

• Special Category

• Full-Time Special (must be approved in advance by Chief of Service and Area Medical Director)

Purpose of the Program

Educational Leave pay is granted for the mutual benefit of the individual physician and SCPMG and provides eligible physicians with pay when they take time away from work for educationally-related purposes such as attending educational meetings, taking courses or participating in university medical teaching, etc. Educational Leave pay may also be requested to study for specialty or subspecialty board exams. Time to take the specialty, subspecialty, or recertification board examination plus appropriate time for travel will be considered work time.

Time off and the use of Education Leave pay must be approved in advance by the Chief of Service and the Area Medical Director.



How the Program Works

Educational Leave pay is a paid benefit. Eligible physicians earn five days of Educational Leave pay per Anniversary Year (prorated to your work schedule). Associate Physicians do not earn Educational Leave during their first year of full-time employment with SCPMG.

You do not have to use your Educational Leave pay in the year it is earned. Your balance will continue to accrue until you reach the maximum of 20 days. At that point, no further days will be earned until your balance is less than 20 days.

Upon approval by the Chief of Service and Area Medical Director, up to a maximum of one year’s Educational Leave pay (five days, prorated to the physician’s work schedule) may be borrowed in advance from your next Anniversary Year. Any days recorded as Educational Leave pay will be unpaid and recorded as leave without pay if your balance is already -5.00 days. You can take Educational Leave in half-day increments. Your Educational Leave pay balance is reflected on your paycheck stub.

Educational Leave may be taken:

• In lieu of regularly scheduled work. Educational Leave is to be scheduled in advance with the approval of the Chief of Service, or

• During non-work hours, i.e., not during regularly scheduled work. Upon approval, you may take up to one day of Educational Leave per calendar year for Continuing Medical Education (CME) activities

For Partner Physicians: Educational Leave pay will not accrue for any physician who is off work and using Chronic Sick Leave, Extended Educational Leave, Extended Military Service Leave, Extended Medical Service Leave, or Military Leave. Special rules may apply for other military-related leaves. Educational Leave cannot follow an overnight duty.

Termination

Unused Educational Leave is not compensable. Physicians will not be permitted to use Educational Leave pay within the 90-day period immediately preceding your resignation or termination.

If you retire from SCPMG, you may be granted Educational Leave pay up to 30 days prior to retirement. If it is taken 30 days prior to retirement, it will be deducted from your Vacation Leave balance or treated as leave without pay.

If you terminate from SCPMG for any reason and subsequently return to SCPMG, you will receive no credit for unused Educational Leave from your prior association with SCPMG.

If you have borrowed Educational Leave and subsequently leave SCPMG, any used but unearned Educational Leave must be repaid.



HOLIDAYS

Eligibility

All Partner and Associate Physicians (excludes Per Diem Physicians and inactive physicians) are eligible for holidays.

Observed Holidays

SCPMG observes six holidays each year. The six observed holidays are:

• New Year’s Day

• Memorial Day

• Independence Day

• Labor Day

• Thanksgiving Day

• Christmas Day


Partner Physicians working less than an 8/10 schedule will be paid for observed holidays on a prorated basis. All Associate Physicians working less than a 10/10 schedule will be paid for observed holidays on a prorated basis. Physicians who work on a holiday will receive additional compensation.

Physicians who have been on leave of absence for more than 30 days will not be paid for observed holidays if the physician is on leave of absence at the time of the holiday.

COMPASSIONATE LEAVE

Eligibility

All Partner and Associate Physicians (excludes Per Diem Physicians) are eligible for Compassionate Leave of Absence.


Up to a maximum of five working days of Compassionate Leave may be extended for the death of members of your immediate family. These family members include your:

• spouse

• domestic partner

• children

• parents

• brothers

• sisters

• grandparents

• grandchildren

• stepparents

• stepchildren

• in-laws (your spouse or domestic partner’s parents, children, brothers, sisters and grandparents)

• legal wards



The amount of Compassionate Leave available is prorated to your work schedule.

Compassionate Leave usage must be approved by your Chief of Service and the Area Medical Director.

JURY DUTY

Eligibility

All Partner and Associate Physicians (excludes Per Diem Physicians) are eligible for Jury Duty.


SCPMG’s Jury Duty policy allows for 10 days of jury service (prorated to work schedule) in any five consecutive calendar years. Any additional Jury Duty time must be taken as Vacation Leave or Leave of Absence (without pay).

If you are required to serve on Jury Duty, you will receive your regular compensation during the period you serve as a juror. Be sure your time is reported as “Jury Duty.” The applicable payment you receive for jury service (normally $15 per day) will be deducted from your paycheck for each day you are paid by the court. You keep the check you receive from the court for jury service (including mileage).

Jury Duty is fully compensable only if you present to your Chief of Service and Area Medical Director all correspondence with the court and its representatives. In addition, you must document all possible steps you have taken to be excused from Jury Duty.

To minimize the impact on patient schedules, check with the court system to see if you can:

• defer jury service to a future date, if needed, to avoid canceling patients

• request “same day” status (in many L.A. courts, this is called “Group 98”), so the court either uses you on a jury or releases you on the first day or

• request a “short trial,” which is defined as less than 5 days Reserve Leave of Absence, you may retain your military reserve income.

SCPMG LEAVES OF ABSENCE

SCPMG offers a variety of leaves to physicians, the terms and conditions of which vary depending on employment status and applicable laws. It is SCPMG’s policy to grant leaves on a non-discriminatory basis. Wherever statutory or other leave provisions overlap, they will run concurrently to the fullest extent permitted. To the extent there is a conflict between federal and state laws, the law most favorable to the employee will apply.



In general, leaves are provided on an unpaid basis, however, physicians may elect (and in some cases, may be required) to use available Sick Leave pay and accrued Vacation Leave towards the leave. In addition, physicians may be eligible for short-term disability and long-term disability benefits as outlined above.

Leaves of Absence (without pay) are available upon approval in advance by the Chief of Services and the Area Medical Director. If the Leave of Absence will be more than 10 days, the Executive Medical Director must also approve it in advance. Unless approved by the Board of Directors, if you are on a Leave of Absence, you may not engage in the practice of medicine for compensation except for a stipend received during a residency or fellowship approved by SCPMG, or pay for working for a Permanente Medical Group, The Permanente Federation, LLC, or The Permanente Company, LLC.

If a physician is on leave without pay for more than (i) 10 working days in any Anniversary Year, or (ii) 60 days in aggregate during your career with SCPMG, then your Anniversary Date will be adjusted accordingly on a day-for-day basis. In addition, if you are a Partner Physician, your Year-End Performance Draw will be reduced proportionately for Leaves of Absence in excess of 10 days during any calendar year, or cumulative Leaves of Absence in excess of 60 days during your career with SCPMG.

Vacation Leave pay accruals will be proportionally reduced in any Anniversary Year that the combined number of days of leave without pay exceeds 10. The reduction will be calculated based on the number of days taken in excess of 10. (Physicians may opt to use accrued paid leave prior to requesting and taking a Leave of Absence.)

For detailed information on the leaves available to SCPMG physicians, please refer to the SCPMG Leave of Absence Policy, which can be found by contacting PHR Shared Services at 1-877-608-0044.


OTHER BENEFITS

SECTION V

166

OTHER BENEFITS 167SECTION: V


OTHER BENEFITS

COMMUTER CHOICE PROGRAM

(For Associate Physicians Only)

The Commuter Choice Program is designed to help you set aside a portion of your income to help pay for public transportation, vanpooling, and parking expenses for your commute to and from work.

The commuter choice benefits described in this section are not subject to ERISA. In the case of any omission or conflict in this handbook, the commuter choice benefit plan rules, the SCPMG Partnership Agreement, SCPMG Rules and Regulations, the minutes of SCPMG’s Board of Directors and the minutes of the Medical Directors, as applicable, always govern.


You may participate in the Commuter Choice Program if you are an Associate Physician (excludes Per Diem Physicians), regardless of your work schedule. Partner Physicians are not eligible to participate in this program.

To enroll in the Commuter Choice Program, visit wageworks.com.

Tax Savings

Your contributions to the Commuter Choice Program will be deducted from your pay on a pre-tax basis. Your contributions reduce your taxable income. The amount you contribute is not subject to federal income taxes, Social Security taxes, or most state and local income taxes. Your reimbursements for eligible expenses are tax-free; you will not be taxed at a later date. Your tax savings will depend on your household income, your tax filing status, and your eligible expenses. Consult your tax adviser if you have any questions.


With a Commuter Choice Account, you can use tax-free funds to pay for public transportation such as train, subway, bus, ferry, trolley, or vanpool and parking you use as your daily commute to work. Your contributions are moved to your account before you pay taxes on them, reducing your overall tax bill.



Limits on Monthly Contributions and Reimbursements

You may make monthly contributions to your Commuter Choice Account up to the maximum limits in effect for the calendar year.

The maximum amount you may contribute will be reduced by any subsidy or discounts that may be provided by a given mode of transportation or facility. For example, if you spend $130 for a transit pass each month and receive a $10 subsidy, the maximum amount you may contribute for transit expenses is $120.

The subsidy will be applied automatically to your transit enrollment, and the remaining pre-tax contribution will be displayed on the WageWorks website. The maximum balance you can have on the WageWorks transit card is $1,500, and the maximum balance for the parking card is the IRS pre-tax monthly limit.

Unused funds from payroll deductions will roll over from month to month and remain in your pre-tax account into the following year.

The IRS announces commuter account contribution limits before the end of each year.

The tax laws cap the total reimbursements you may receive from your account for eligible expenses incurred during any calendar month. Separate reimbursement limits apply to eligible expenses for (1) transit passes and vanpooling, and (2) qualified parking.

For current or previous annual contribution limits, refer to the WageWorks website at wageworks.com.

Changing Your Contributions

To make a change, select the View my Commuter Choice Account link and go to your Commuter program. Choose Change or Cancel from the menu or select the listing for the order itself. Click on the link to change or cancel your Election amount for the month and follow the instructions provided. These instructions may change from time-to-time so if you have questions on changing your contributions, contact WageWorks.

If your account begins to accumulate a significant balance, you may stop or reduce your contributions on a temporary basis until you have used your balance.

Eligible Expenses

Expenses generally eligible for reimbursement from your Commuter Choice Account include:

• transit passes, including bus, train, subway, and ferry fares and passes

• vanpooling (seating capacity of 6 or more adults, excluding driver, where 80% or more of miles for which vehicle is used for transporting employees back and forth between work and home during which trips the vehicle is at least 50% full)

• parking at transit station facilities or at or near work


For a current list of eligible expenses, refer to the WageWorks website at wageworks.com.

Ineligible Expenses

Expenses not eligible for reimbursement from your Commuter Choice Account include:

• carpooling expenses

• non-work related transportation and parking

• parking/transportation expenses reimbursed by SCPMG

• monthly expenses above the reimbursement limits described under Limits on Monthly Contributions and Reimbursements above

• bridge/road tolls and transponders

• gasoline expenses

• parking/transportation expenses for your spouse, domestic partner or dependents

For a current list of ineligible expenses, refer to the WageWorks website at wageworks.com.

Rollover of Unused Funds and Termination

Any unused funds remaining in your Commuter Choice Account will roll over to the following month (including the following year if December). These funds will remain in your account to reimburse you for eligible expenses. Your reimbursements will continue to be limited to the reimbursement limits described under Limits on Monthly Contributions and Reimbursements above. Since funds can roll over from month to month, your account balance remains available so long as you are an Associate Physician with SCPMG. If your account balance grows to a significant amount, you may wish to temporarily stop contributions and reduce your account balance through reimbursements of your eligible expenses.

You may continue to request reimbursement for eligible expenses until you stop participating in the program (refer to If You Terminate Employment below). If you terminate from SCPMG, your participation in the program will automatically terminate at the end of your termination month or upon transferring to Partnership status.

Claims Administrator

The program is administered by WageWorks, who maintains your account records, issues reimbursements, and provides you with individual account statements. Send all claims to:

Claims AdministratorP.O. Box 14053Lexington, KY 40512


Your participation ends:

• on the day you retire, terminate employment, or become ineligible (including election to the Partnership)

• if you go on an unpaid leave of absence

If you become ineligible for the benefit at any time during the year because you go on leave, all future Commuter Choice Account elections will be canceled. When you return from leave of absence, you will need to reenroll.

You will have 90 days after becoming ineligible to use any funds that remain on your Transit Commuter Card. Any funds on your Parking Commuter Card will be immediately forfeited.

FLEXIBLE SPENDING ACCOUNTS


SCPMG offers two flexible spending accounts to eligible Associate Physicians:

• Health Care Flexible Spending Account (Health Care FSA)

• Dependent Care Flexible Spending Account (Dependent Care FSA)

The Flexible Spending Account tax benefits are not available for Partner Physicians under the Internal Revenue Code. Therefore, in this section, “you” refers only to Associate Physicians.

The flexible spending accounts allow you to set aside a portion of your pay through payroll deductions on a pre-tax basis to reimburse eligible health care and dependent care expenses that your benefits do not otherwise cover. The money you would have paid in taxes can instead be used to pay for qualified health care and dependent care expenses.

Since there is a tax advantage to participating in the spending accounts, the Internal Revenue Service (IRS) has strict rules and requirements for using the accounts. This section describes the general rules and requirements that are common to the spending accounts.

Who Is Eligible

You are eligible to participate in the Health Care FSA and the Dependent Care FSA if you are an Associate Physician.

There are additional eligibility requirements for the Dependent Care FSA Refer to “Additional Eligibility Requirements” for the Dependent Care FSA for more information. You cannot be reimbursed for dependent care expenses incurred while you are on a leave of absence.



When You Can Enroll

You may enroll in the Health Care and/or Dependent Care Flexible Spending Accounts at the following times:

• within 31 days of your date of hire

• during the annual open enrollment period for the following plan year

• within 31 days of a qualifying family or employment status change

Payroll deductions for flexible spending accounts will appear on your pay notice after participation begins.

Continuing Your Flexible Spending Account

You must re-enroll in your Health Care and/or Dependent Care Flexible Spending Accounts each year during open enrollment to continue participation. Otherwise, your contributions will revert to $0.

How the Spending Accounts Work

Based on your expected eligible health care and dependent care expenses, you decide how much you want to contribute to the Health Care and/or Dependent Care Flexible Spending Accounts, up to the plan contribution limits.

The amount you choose to put in an account is contributed over the plan year in equal installments. Since contributions are made before taxes are withheld, you do not pay Social Security tax, federal income tax, and in most areas, state income taxes on the money you put into a spending account.

When you have an eligible expense, you submit a claim for reimbursement to WageWorks, the third-party administrator. For Health Care FSA claims, you can also use the WageWorks® Healthcare Debit Card, the debit card issued by WageWorks. For information or to access your account, contact WageWorks at 1-877-924-3967 or online at wageworks.com. Service representatives are available from 5 a.m. to 5 p.m. Pacific time, and automated information on your account is available 24 hours a day.

For more details on how to file a Health Care FSA claim refer to the Claims, Appeals and Administrative Information section. For information on how to file a Dependent Care FSA claim refer to “Filing a Claim” under the “Dependent Care Flexible Spending Account” section.

Rules You Should Know

The following restrictions apply to flexible spending accounts:

• You must enroll each year during open enrollment if you wish to contribute to a flexible spending account for the following year. Your election does not automatically carry over from year to year. If you do not submit an election, your contribution will revert to $0 and you will not be enrolled for the following plan year.



• Flexible spending accounts have different use-or-lose rules.

– Health Care FSA: You cannot receive a refund of your remaining Health Care FSA balance. However, you may carry over up to $500 into the following plan year. Any remaining balance in excess of $500 for which you have not filed eligible claims by March 31 of the following plan year will be forfeited.

– Dependent Care FSA: You cannot receive a refund or carry over your balance from one year to the next. This means that you need to calculate your expenses carefully to avoid overestimating.

• Expenses incurred prior to the effective date of your participation are not eligible under the flexible spending account plan rules and will not be reimbursed.

• The contributions that you make during a plan year must be used for expenses incurred while you are participating in the plan during that calendar year, except for the $500 Health Care FSA balance that you can carry over from one year to the next. However, you have until March 31 of the following year to file your claims.

• IRS regulations require that if you are absent from work for more than two consecutive calendar weeks for any reason, your participation in the Dependent Care FSA will be suspended until you return to work. Any expenses incurred during the period you were not actively participating in the Dependent Care FSA are not eligible for reimbursement.

• If you return to work from a leave of absence during the same plan year, you continue to be responsible for your original annual election amount. Therefore, your Dependent Care FSA/Health Care FSA will restart when you return to active employment and your contributions will be increased so that at the end of the year you will have contributed the full amount of your annual election. However, you must notify the PHR Shared Services within 31 days of returning from a leave of absence in order to enroll in the plan or change your contribution amount.

• If you participate in both the Health Care FSA and the Dependent Care FSA, the two flexible spending accounts are completely separate. You cannot transfer funds from one account to the other or use the funds in one account to pay for expenses covered under the other account.

• You will not be able to change your contribution amount or enroll in the plan outside of open enrollment unless you have a qualifying family or employment status change. Refer to the Enrolling/Deleting Eligible Dependents (also referred to as Family Status Changes) section for more information.

• IRS rules require flexible spending accounts to be nondiscriminatory with regard to participation rates and average salary reduction amounts. If you are highly compensated (as defined by statute), the amount of your contributions may be reduced below the annual maximums to comply with the rules. You will be notified during the year if this reduction applies to you.



• If you terminate your employment with SCPMG or become ineligible to participate in the flexible spending accounts, you may only continue to file claims for expenses incurred prior to your termination or change in status. Claims must be filed by March 31 of the year following your termination or change in status. You may also elect to continue participation in the Health Care FSA through COBRA for the remainder of the year, and submit claims for eligible expenses incurred after your termination or change in status date. However, your contributions will be made on an after-tax basis, so you will not realize any tax savings.

Tax Considerations

When you contribute to a flexible spending account, you lower your current Social Security, federal income tax, and in most cases, state income taxes. Another way to lower your income tax is to take a tax deduction for your eligible medical expenses or tax credit for dependent day care expenses when you file your income tax return. If you use the flexible spending accounts, you cannot also claim a federal or state tax deduction or credit for the same health care and/or dependent care expenses on your tax return. You may want to consult your tax advisor for more information about the best choices for your situation.

When You Leave

If you have a balance in your Health Care FSA or Dependent Care FSA when your employment ends, you may continue to submit claims until March 31 of the following year for eligible expenses incurred prior to your termination date. Any funds that cannot be reimbursed for qualified expenses will be forfeited to the plan. You may be able to continue your Health Care FSA participation through the end of the plan year if you continue to make contributions to the plan on an after-tax basis under COBRA. Refer to the Continuation of Coverage under COBRA for more information.

HEALTH CARE FLEXIBLE SPENDING ACCOUNT


You can enroll in a Health Care Flexible Spending Account (Health Care FSA) to set aside pre-tax dollars for anticipated health care expenses not covered by your medical and dental plans, such as deductibles and copayments. The Health Care FSA is subject to ERISA.

Your Contributions

The maximum Health Care FSA annual contribution for 2019 is $2,650. Your contributions are deducted from your pay in 24 equal amounts, which are reflected on the first two pay statements of each month throughout the year. The minimum pay period contribution is $10. If you become eligible for the Health Care FSA in mid-year, the full annual maximum is still available to you. In other words, you may elect a higher per-pay-period contribution in order to contribute the maximum amount over the remaining pay periods for that calendar year.



Carryover Contributions

You may carry over up to $500 of your unused Health Care FSA funds into the following plan year — regardless of whether you elect to make new Health Care FSA contributions.

The $500 carryover limit is separate from the annual plan maximum allowed under federal guidelines. This means your carryover balance is added to your Health Care FSA contributions for the new plan year.

If you do not make new Health Care FSA contributions for the following plan year during the annual open enrollment period, you may use your carryover balance.

If at the end of the new plan year you have an unused balance, you may again carry over up to $500 into the following plan year.


You may change the amount you contribute to a Health Care FSA during the annual open enrollment period, for participation during the following year.

You cannot change your flexible spending account contributions during the year unless you have a qualifying change in family or employment status. For a list of qualifying events, refer to the Enrolling/Deleting Eligible Dependents (also referred to as Family Status Changes) section.

You have 31 days from the date of the qualifying event to contact PHR Shared Services to start, stop, increase, or decrease contributions to a Health Care FSA. The contribution change must be consistent with the applicable event. For example, if your dependent child loses eligibility for benefits because he or she reaches the age limit, you may not increase your contributions to your Health Care FSA.

Eligible Dependents

You can use the Health Care FSA to pay for eligible health care expenses for yourself, your spouse, and your children — even if they are not eligible for, or enrolled in, one of the SCPMG-sponsored health care plans. You may also use the Health Care FSA for other members of your family and household if they qualify as your tax dependent for health coverage purposes. Family and household members whose expenses are eligible for reimbursement from the Health Care FSA include the following:

• your spouse (unless you are divorced, legally separated, or your marriage was annulled)

• your or your spouse’s child, legally adopted child, or a child placed with you for legal adoption under the age of 26, regardless of tax-dependent status



• any relative, including a child age 26 or older, grandchild, brother, sister, parent, aunt, uncle, niece, or nephew, if you provide over one-half of his or her support in the calendar year

• any non-relative who is a member of your household, including a qualified domestic partner who resides with you for the entire calendar year and receives more than one-half of his or her support from you and qualifies as a dependent on your federal income tax return

To be eligible, a child cannot be the qualifying child of another person. For example, if your domestic partner’s child lives with you, that child cannot be your eligible dependent for the Health Care FSA if he or she is the tax dependent of your domestic partner or the child’s other parent, even if you provide more than half the support for that child.

If an eligible child is not your tax dependent, a reimbursement claim for that child might need to be reported as taxable income for state tax purposes only.

Remember, the definition of eligible family members for the Health Care FSA may differ from the one used for dependent medical and dental coverage and from the one used in determining your personal income taxes.

Contact your tax advisor if you have questions about an individual’s qualification as your tax dependent.

Eligible Expenses

You may use your Health Care FSA to pay for expenses not covered or reimbursed through any health care plan. Below are some of the most common eligible Health Care FSA expenses:

• acupuncture

• alcoholism or drug dependency treatment

• ambulance services

• automobile modifications for disabled (Letter of Medical Necessity required)

• birth control that has been prescribed

• body scans for preventive purposes

• chiropractic care

• contact lenses, contact lens solution and eyeglasses

• deductibles and copayments

• dental treatment (excludes teeth whitening)

• expenses over your health care plan limits

• eye surgery, radial keratotomy, LASIK and vision correction



• guide dog, service animal, or other such animal (Letter of Medical Necessity required)

• hearing aids and hearing-impaired equipment

• home health care

• immunizations

• infertility treatments

• insulin, glucose monitoring kits and diabetic supplies

• lab and X-ray fees that are part of medical care

• learning disability tuition (Letter of Medical Necessity required)

• massage therapy (Letter of Medical Necessity required)

• medical records charges

• medical supplies and equipment, including wheelchairs

• mental health counseling and/or psychiatric care

• nursing services

• orthodontia

• orthopedic shoes and orthotic inserts

• osteopathy services

• oxygen and oxygen equipment

• physical therapy

• podiatric services

• prescription medicine and drugs that are legal in the United States (You may use your account to be reimbursed for over-the-counter (OTC) drugs and medicines if you obtain a prescription for the OTC items from your healthcare provider first. When submitting the OTC claim to WageWorks, include a copy of the prescription along with the detailed receipt.)

• prosthesis (artificial limb)

• smoking cessation programs (nicotine patches, lozenges, and gum require a Letter of Medical Necessity or prescription)

• speech therapy

• surgery (includes cosmetic surgery with a Letter of Medical Necessity)

• sterilization procedures

• transportation expenses for person receiving medical care

• weight-loss programs (with a Letter of Medical Necessity referring to the underlying condition of obesity and stating that the program will treat the condition). Expenses for dietetic food are not eligible

• other medical expenses that qualify under the IRS rules governing a Health Care FSA and are not reimbursable under any other health plan



Prequalification

Your Health Care FSA annual election is irrevocable under IRS rules, except in the event of a qualifying family or employment status change. Please check with your provider before you enroll in the Health Care FSA to make sure that you qualify for reimbursement from the Health Care FSA for any procedure or medical service you may be planning. Once you have enrolled, you cannot stop or change your Health Care FSA contributions during the year if your physician or provider determines you are not a qualified candidate for a procedure you had planned to pay for using Health Care FSA funds.

Expenses Not Covered

The following are examples of expenses that may not be eligible for reimbursement from your Health Care FSA as of the date of this Handbook.

• babysitting, to enable you to make doctor visits

• contact lens insurance

• dietary, nutritional, and herbal supplements used to maintain general health

• exercise equipment and programs to promote general health

• funeral, cremation, or burial services

• long-term care

• premiums for medical or dental care, life insurance, or disability plans

• prepayments for services not yet incurred

• over-the-counter (OTC) drugs or medications (except insulin) that you do not have a prescription for, including but not limited to the following: cold and flu medicine; cough suppressants, allergy and sinus medicine; eye drops; pain relievers; toothache remedies; and topical products (i.e. Bengay, Neosporin)

For a full and updated list of covered services and exclusions, contact WageWorks.

Using Your Healthcare Debit Card

You will receive a WageWorks® Healthcare Debit Card that you can use to pay for eligible Health Care FSA expenses such as medical copays and prescriptions. The card works like a debit card that will be preloaded with your Health Care FSA balance. The Healthcare Debit Card is regulated by IRS rules, and in some cases you may be asked to provide WageWorks with documentation to verify that the item or service purchased was an eligible expense. You can mail copies of your documentation to WageWorks or submit them online at wageworks.com using the “Submit Receipt” link.



For additional information on the Card Verification process, please contact WageWorks.

Filing a Claim

When you have an eligible expense, you submit a claim for reimbursement to WageWorks, the third-party Administrator. You may obtain a Health Care Flexible Spending Account reimbursement claim form from WageWorks. You may contact their Customer Service center at 1-877-924-3967 or obtain claim forms from their website at wageworks.com.

For more information about how to file a Health Care FSA reimbursement claim, and how to file an appeal if your claim is denied, refer to the Claims, Appeals and Administrative Information section.

Health Care Flexible Spending Account COBRA Continuation

COBRA coverage under the Health Care FSA is offered to qualified beneficiaries who were enrolled in the Health Care FSA on the day before the qualifying event and have voluntary contributions remaining in their accounts.

You may elect to continue to participate on an after-tax basis when you receive the COBRA election packet. However, you will be responsible for sending your current contribution each month directly to WageWorks, the plan administrator. This payment — made payable to WageWorks — should be mailed as a separate check each month. Please mail your check to the following address:

WageWorksClaims AdministratorPO Box 14053Lexington, KY 40512

If you fail to send your contributions by the due date, you will no longer be considered a participant in the plan. Expenses can be claimed up to the maximum amount elected for the calendar year, provided the eligible expenses are incurred while you are an active participant in the plan. Claims must be submitted prior to March 31 of the following year. The use-or-lose rule will continue to apply, so any funds unclaimed after this date will be forfeited.

DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT


You can enroll in a Dependent Care Flexible Spending Account (Dependent Care FSA) to set aside pre-tax dollars for eligible dependent care expenses throughout the plan year. This benefit provides tax savings if you need dependent care services — for your children, a disabled spouse, or a disabled dependent living with you and incapable of self-care — in order to work.



Additional Eligibility Requirements for the Dependent Care FSA

In addition to the general eligibility rules for spending accounts, there are several eligibility requirements specific to a Dependent Care FSA. Federal tax laws require that you meet one or more of the following conditions:

• you are a single working parent

• you and your spouse both work

• you are a divorced working parent and have custody of the child(ren)

• your spouse is a full-time student for at least five months of the plan year

• your spouse is unemployed and actively seeking work

• your spouse is mentally or physically impaired and incapable of self-care

Eligible Dependents

Expenses reimbursed through a Dependent Care FSA must be for eligible dependents (as defined by IRS rules). For the purposes of this plan, eligible dependents include the following:

• your IRS tax-dependent child under age 13 who resides with you for more than half of the calendar year

• your child under age 13 for whom you are the custodial parent for more than half of the calendar year but due to a divorce you have filed an agreement to give the non-custodial parent the tax exemption

• your spouse who is mentally or physically incapable of self-care and who resides with you for more than half of the calendar year

• other qualified dependents who are mentally or physically disabled and unable to care for themselves, and who reside with you for more than half of the calendar year

Expenses for care provided outside your home can be reimbursed only if the care is for your dependent under age 13 or any other qualifying person who regularly spends at least eight hours a day in your home.

The qualifying child of another taxpayer cannot be claimed as your eligible dependent. For example, you are not able to be reimbursed for expenses for the child of a domestic partner if the domestic partner claims the child as a dependent on his or her tax return or the child’s other parent claims the child as a dependent. Domestic partners and their children are considered eligible dependents for this plan only if they qualify as your dependent for federal income tax purposes.

Your child cannot be an eligible dependent if you are divorced and do not have custody of the child, unless the custodial parent provides you with a signed, written declaration that he or she will not claim the child as a dependent on his or her tax return.



Remember, the definition of dependents for the Dependent Care FSA may differ from the one used for your medical and dental coverage and from the one used in determining your personal income taxes. You may want to contact your tax advisor if you have questions about an individual’s qualification as your dependent for purposes of eligibility to participate in the Dependent Care FSA.

Eligible Providers

Expenses reimbursed through a Dependent Care FSA must be for care provided by an eligible provider. Eligible providers include the following:

• family members who cannot be claimed as dependents on your income tax return

• your children who are age 19 or older

• dependent care centers or licensed day care providers that comply with applicable state and local laws

Eligible Expenses

The IRS determines which qualifying expenses are eligible for reimbursement. Only dependent caretaking expenses that are employment related and necessary for you to be gainfully employed qualify for reimbursement. Some of the most common eligible Dependent Care FSA expenses for services in or out of your home include the following:

• care at a licensed day or evening care center or after school care

• in home baby-sitting services, such as an au pair or nanny

• the cost of day camps (fees for supplies do not qualify)

• practical nursing care for an adult

• care inside or outside your home for your dependent under age 13 or any other qualifying dependent who regularly spends at least eight hours a day in your home

Expenses Not Covered

The following are some of the expenses that may not be eligible for reimbursement from your Dependent Care FSA:

• overnight camps

• cost of a babysitter for personal purposes that are not employment related

• care provided by your child under age 19 or by someone you claim as a dependent on your tax return

• kindergarten or educational tuition expenses

• summer school



IRS regulations require that if you are absent from work for more than two consecutive calendar weeks for any reason, your participation in the Dependent Care FSA will be suspended until you return to work (any expenses incurred during the period you were not actively participating in the Dependent Care FSA, are not eligible for reimbursement).

For a full and updated list of covered services and exclusions, contact WageWorks.

Your Contributions

For the entire plan year, the minimum per-pay-period contribution is $10. The maximum you can contribute to a Dependent Care FSA account depends on your family situation. Your contributions may not exceed the lesser of the following in 2019 and may change from time to time:

• $5,000 each year if you are single, head of household, or married. If your spouse also has a Dependent Care FSA account with SCPMG or with another employer, the limit applies to your combined contributions

• $2,500 a year if you are married and file separate tax returns

• The amount of your salary or the amount of your spouse’s salary if he or she earns less than $5,000 a year

If you become eligible for the Dependent Care FSA in mid-year, the full annual maximum is still available to you. In other words, you may elect a higher per-pay-period contribution in order to contribute the maximum amount for that calendar year.

Your Dependent Care FSA annual election is irrevocable under IRS rules, except in the event of a qualifying family or employment status change. Your Dependent Care FSA contribution amount should be based upon a careful estimate of expected dependent care expenses for your qualified dependents for the calendar year or the portion of the year in which you are a participant. Your annual election is deducted from your pay in 24 equal amounts, which are reflected on the first two pay statements of each month throughout the year.

Per IRS regulations, the Dependent Care FSA is intended to help you pay for eligible dependent care expenses to allow you to work. Therefore, if you take any type of leave of absence for more than two consecutive calendar weeks, your Dependent Care FSA contributions will stop; you cannot be reimbursed for expenses incurred while you are on leave. As soon as you return from your leave, you will resume participating in the plan.

Additional federal limits may apply. For more information, contact WageWorks.




You may change your contributions each year during open enrollment for the following plan year. You may not change your election during the plan year unless you have a qualifying family or employment status change. For a list of qualifying events, refer to the Enrolling/Deleting Eligible Dependents (also referred to as Family Status Changes) section.

You have 31 days from the date of the qualifying event to contact the PHR Shared Services to start, stop, increase, or decrease contributions to a Dependent Care FSA. The contribution change must be consistent with the change in family or employment status.

Filing a Claim

Dependent Care FSA claim forms are available from WageWorks at wageworks.com. Submit the completed claim form, including your provider’s signature to WageWorks.

You may file your claim with the WageWorks EZ Receipts® mobile application (available at wageworks.com). For the fastest reimbursement, submit your claim online at wageworks.com. You may also fax it to 1-877-353-9236, or mail it to the following address:

WageWorksClaims AdministratorP.O. Box 14053 Lexington, KY 40512

You will be reimbursed only up to the amount you have already contributed to your account; outstanding amounts will be automatically paid as you contribute more to your account. You may submit claims until March 31 of the following year for expenses incurred through December 31 of the previous year (the end of the plan year).

WageWorks processes claim forms for reimbursement once a week, but you will need to allow for mailing time in both directions. Reimbursement is available by check or direct deposit.

If your Dependent Care FSA claim is denied, you do not have rights to an appeal under ERISA, but you may request a review of the denial by contacting WageWorks. If you have questions about your flexible spending account or claims, or if you need a claim form, contact WageWorks.

How Other Benefits Are Affected

Your Flexible Spending Account contributions will not affect your other SCPMG benefits that are based on your pay. These other benefits such as life insurance, disability, and retirement benefits will continue to be based on your full pay.



When Your Participation Ends

Your participation in the Health Care FSA and Dependent Care FSA end and your contributions stop when the first of these events occurs:

• you are no longer eligible to participate

• you fail to make an election for a benefit plan year

• the plan terminates

• your employment is terminated

• you discontinue contributions following a change of status

LONG-TERM CARE INSURANCE

Long-Term Care Insurance is designed to provide you and/or your eligible family members with financial protection for services rendered in connection with nursing home and/or home- and community-based care. Coverage is available at your own expense.

The terms of the Long -Term Care Insurance benefit for both New York Life Insurance Company and Genworth Life Insurance Company are contained in insurance certificates (sometimes referred to as an insurance contract in this Handbook), which are incorporated by reference into this Handbook. In case of any omission or conflict between what is written in this Handbook and in the applicable insurance certificate, the insurance certificate always governs.

Through New York Life Insurance Company

The information presented below is applicable to policies purchased through New York Life Insurance Company prior to November 2012. New York Life has since suspended new enrollment. If you enrolled in Long-Term Care Insurance through New York Life prior to November 2012, you may generally keep your contract provided you continue to pay the premium for the coverage, and subject to any other terms and conditions set forth in the insurance certificate.

Eligibility

Generally, all active Partner and Associate Physicians (except Per Diem Physicians) were eligible to enroll without providing evidence of insurability prior to November 2012:

• upon hire

• upon election into SCPMG Partnership

• upon attainment of age 40



Family Members’ Eligibility

Your eligible family members may have applied for this insurance whether you applied for this coverage or not.

Coordination with Other Benefits

Long-Term Care Insurance is coordinated with your SCPMG Supplemental Medical coverage.

Any claims that are eligible for payment under Supplemental Medical coverage should be filed first with that plan. After you have been reimbursed for any eligible charges by the Supplemental Medical coverage, then submit the unpaid balance to your Long-Term Care Insurance.

By coordinating the benefits in this manner, your lifetime maximums under Long-Term Care Insurance can be extended.

Through Genworth Life Insurance Company

Long-Term Care Insurance through Genworth Life Insurance Company was closed to new enrollment effective January 1, 2017. The information below is applicable for those currently enrolled in the plan. If you enrolled in Long-Term Care Insurance through Genworth Life Insurance Company prior to 2017, you may generally keep your contract provided you continue to pay the premium for the coverage, and subject to any other terms and conditions set forth in the insurance certificate.

Effective March 2014, SCPMG began offering Long-Term Care Insurance underwritten by Genworth Life Insurance Company. This program was available to Partner Physicians, their spouses or domestic partners, and other family members. The terms of the Long-Term Care Insurance benefit are contained in an insurance certificate, which is incorporated by reference into this Handbook. Generally, eligible individuals included:

• Partner Physicians working at least 20 hours per week

• Family members of an eligible Partner Physician who are between ages 18 and 75, including your:

– spouse or domestic partner

– adult children

– siblings

– parents, parents-in-law, stepparents, stepparents-in-law

– grandparents, grandparents-in-law, stepgrandparents, stepgrandparents-in-law

For detailed information about Long-Term Care Insurance through Genworth, including costs and what the program covers, refer to the insurance certificate.



IDENTITY THEFT PROTECTION Through Identity Guard

SCPMG physicians can enroll in a voluntary plan for identity theft protection through Identity Guard.

The program is intended to help you take control of your personal information to avoid fraud, theft, or misrepresentation of your information, and you should receive regular alerts when your information is being utilized even in the black market.

You are sent early warning alerts that help you stay ahead of fraudsters and stop potentially damaging activity before it becomes a problem. Refer to the sections below for a summary of key components of the program.

Please note that the terms of the identify theft protection program are contained in a program agreement. In case of any omission or conflict between what is written in this Handbook and in the agreement, the agreement always governs. Note that ERISA does not govern this identity theft protection program.

Eligibility

Active Partner and Associate Physicians may enroll in identity theft protection at a negotiated rate by logging on to benefits.identityguard.com/scpmg. You are eligible to enroll in this program at any time.

Enrollment

The online enrollment process usually takes a few minutes to complete. You will be asked to provide personal information to set up your enrollment. Keeping your information private is important – your information will generally never be shared with anyone outside of Identity Guard.

Should you have any questions about Identity Guard membership or if you need assistance completing your enrollment, please contact an Identity Guard Member Services representative at 1-888-366-4076.



Paying for Membership

Your membership fees will be deducted directly from your paycheck on a monthly basis. If you resign or retire from SCPMG, you may continue your Identity Guard coverage; however, you will need to re-enroll and set up automatic payment via credit card. Please call 1-888-366-4076 for more information.

There are four different levels of membership as of the date of this Handbook and may change from time to time:

Coverage Level Monthly Payroll Deduction

Physician Only

Individual plan covers one adult (18

years or older)

$10.00

Physician & Spouse/Domestic Partner

Plan covers physician and spouse/domestic partner in a single household (18 yearsor older)

$17.50

Physician & Children

Plan covers physician and minor

children (under 18 years old)

$14.00

Physician & Family

Plan covers physician, spouse/domestic partner (adult 18 years or older), and minor children (under 18 years old)

$21.00

Spouse/Domestic Partner Coverage

After the SCPMG Physician (also known as the Primary Member under the program) is enrolled in either the Physician & Spouse plan or the Physician & Family plan, an email containing a unique activation link will be sent to the email address provided by the physician during the account creation process.

The enrolled physician may not perform the activation for the spouse/domestic partner. The physician must forward the email to the spouse/domestic partner (also known as an Added Member under the program) the physician would like to enroll in the program so that the spouse/domestic partner can activate his/her own membership. The spouse/domestic partner must then complete the activation process. The spouse/domestic partner is not charged separately as his/her cost is included in the monthly fee paid by the physician based on coverage level and paid by payroll deduction.



A spouse/domestic partner has 90 days from the date of enrollment of the physician to activate his/her account. If a spouse/domestic partner fails to activate their account within that activation period, or the spouse/domestic partner cancels the service after activation, the monthly membership fee charged to the physician will be automatically reduced to the applicable coverage level.

For example:

Physician Selects the “Physician and Family plan” at initial enrollment online:

If spouse/domestic partner cancels or does not activate their own enrollment, the physician’s monthly fee is reduced:

Physician & Family plan - $21.00

Physician, spouse/domestic partner (adult 18 years or older) & minor children (under 18 years old)

Physician & Children plan - $17.50

Physician & minor children (under 18 years old)

Physician & Children

In the event of disruption in employment (i.e. physician goes on medical leave of absence and is no longer having the fees deducted from their paycheck) and the duration is longer than 30 days (one missed monthly payment), coverage continues. However, if payroll deductions do not resume after two missed deductions, the physician and spouse/domestic partner must re-enroll in the program.

The physician and spouse/domestic partner may cancel membership any time by contacting the Identity Guard Member Services team at 1-888-366-4076. In addition, a spouse/domestic partner may cancel his or her activation at any time by calling the above Member Services number.

Child Enrollment Process

In the event you wish to add your child to the program, you would click on the “Add My Child” button in the Identity Guard member area. The “Add My Child” button will only be available for children and family plans. The enrollment process is subject to change from time to time so contact Identity Guard at 1-888-366-4076 if you have questions.

Coverage for a Child Over Age 18

Coverage is available for each adult child over 18 years of age at the same discounted “Physician Only” rate. However, premiums for this coverage cannot be paid through a physician’s monthly payroll deduction. Premiums must be paid via credit card only. Adult children over the age of 18 can enroll in the program by visiting benefits.identityguard.com/scpmgfamily and by clicking on “Get Protected” to complete the enrollment process.



Product Features

For a description of the features of the identity theft protection program, contact Identity Guard at 1-888-366-4076.

MORTGAGE LOAN PROGRAMS

The following mortgage loan programs may provide favorable residential mortgages for eligible SCPMG physicians. These programs are generally designed to provide higher loan amounts, lower up-front costs and flexible financing options.

Eligibility

All Partner and Associate Physicians (excludes Per Diem Physicians) may be eligible for these programs.

How to Apply

For further information or to request an application form, contact the following bank representatives:

• Bank of America: Tina Vo, 1-714-595-5181 [email protected] (NMLS ID: 450331) [email protected] mortgage.bankofamerica.com/tina-vo

• Union Bank: Jered Barger, 1-619-847-5080 [email protected] (NMLSR #448544) [email protected]

• Wells Fargo: Thomas John Lieb III, 1-626-585-4726, [email protected] (NMLSR ID: 483630) wellsfargorelo.com/kaiserSC

This list is subject to change from time to time. Contact PHR Shared Services for a current list.

STUDENT LOAN REFINANCING BENEFITS

SCPMG has partnered with First Republic Bank and CommonBond to offer all SCPMG physicians with certain student loan refinancing benefits. Under this program, you or your dependent’s student loans will be paid off and replaced with one combined loan, which could help you lower your student loan payments, take control of your debt, and pay off your student loan debt faster.



What else you might like to know

First Republic Bank

• Access to among the lowest fixed rates in the country

• You will have access to a dedicated personal banker

• Full service banking with options for virtually every life stage

• Amount you can refinance: $25,000-$300,000

CommonBond

• Borrower protections like deferment, forbearance, and forgiveness in the event of death or disability

• Competitive rates

• Access to the CommonBond team via phone, email, and live chat

• Amount you can refinance: $5,000-$500,000

Note: This information is subject to change.

How to Learn More

For further information, contact the following:

First Republic BankVisit: firstrepublic.com/scpmgEmail: [email protected]: 1-310-407-1333

CommonBondVisit: cbpartner.com/scpmgEmail: [email protected]: 1-833-988-3620

PROFESSIONAL LIABILITY COVERAGE

This plan provides financial protection for physicians against malpractice claims that may be filed as a result of actions taken or not taken within the course of the scope of your professional duties performed for SCPMG.

This coverage may not be declined.

Eligibility

This coverage is provided for all physicians.

Enrollment

Coverage is automatic; no enrollment is necessary.



Effective Date

The coverage is effective on your date of hire.

Description

Complete professional liability coverage is provided on a date-of-occurrence basis; this means you are covered for professional activities performed for SCPMG even if you are no longer on staff when the action is filed.

Covered Outside Activities

Coverage is also available for approved outside professional activities for all SCPMG physicians (excludes part-time and Per Diem Physicians). Professional activities, other than those performed for SCPMG, which may also be covered include:

• assistance given at an outside emergency (such as first aid at the scene of an accident),

• participation in approved outside educational activities, whether on SCPMG or personal time (any professional liability coverage provided by the academic institution would be used first), and

• volunteer community activities when there is no other malpractice coverage available, as long as:

– the services are provided without compensation

– the services are for a well-established, well-recognized nonprofit civic or community organization

– the physician meets community standards (by training and experience) to provide the required professional services

– the volunteer activity is not considered “high risk,” and

– approval is obtained as described below

Approval Required for Outside Activities

To be covered while providing volunteer services, you must:

• obtain a Voluntary Activity Report available at kpnet.kp.org:81/california/qmrs/scpmglegal/physician_volunteer_activities.html

• complete either the paper version or the electronic version and send it to SCPMG Counsel at Walnut Center

• be approved for coverage by your Area Medical Director and the SCPMG Legal Department

All requests will be approved or denied based on the criteria above.



Condition of Coverage

As a condition of professional liability coverage, you must:

• cooperate in the investigation and/or defense of malpractice claims

• use legal services exclusively provided or selected by SCPMG

• attend meetings, hearings, depositions, arbitrations and trials as requested by your attorney, and

• assist in effecting settlement

The time you spend on these activities will be administrative time. If you are no longer associated with SCPMG, you will receive payment at the last hourly rate of pay while with SCPMG for time spent in actual attendance. There will be no additional charge by you to the entities of Kaiser Permanente for these services.

Exclusions

Any practice outside SCPMG is not covered. This includes any services rendered for which value is received by you. It is most important that all services for which payment is expected be billed through SCPMG.

Service as a camp doctor in any camp run for profit, whether you receive direct compensation or not, is not covered.

Termination

This coverage terminates on the date your service with SCPMG ends; however, you will be protected for all professional activities you performed for SCPMG regardless of when the suit is filed.

No Conversion

Conversion to individual coverage is not available.

Cost

This coverage is provided at no cost to all physicians.



RETIREMENT AND SAVINGS PLANS

SECTION VI

192

RETIREMENT AND SAVINGS PLANS 193SECTION: VI


RETIREMENT AND SAVINGS PLANS

As an SCPMG physician, you have a number of retirement plans available to you. Kaiser Foundation Health Plan, Inc. (KFHP) provides the Common Plan and SCPMG provides three Retirement and Savings Plans that may assist you in your retirement years:

• Common Plan, provided by KFHP, is generally available to eligible physicians to provide a monthly retirement income. Please refer to the Summary Plan Explanation provided by KFHP for detailed information on the Common Plan.

All information about the Common Plan contained in this Handbook and other SCPMG documents are based on SCPMG’s understanding of the rules and are for your convenience only, since only KFHP (and not SCPMG) can change and interpret the Common Plan. For any questions regarding the Common Plan, contact the Kaiser Permanente Retirement Center at 1-800-721-3647.

• SCPMG Keogh Plan (Keogh Plan), formerly known as the Southern California Permanente Medical Group Retirement Plan, is available to Partner Physicians, certain Partner Emeriti, and Business Administrators. The Keogh Plan enables participants to accumulate pre-tax savings through convenient payroll deductions or through lump sum contributions to the plan (for full-year Partner Physicians only). The Keogh Plan provides a wide choice of investment options.

• SCPMG Physicians’ 401(k) Plan (401(k) Plan), formerly known as the Physicians’ Tax Savings Retirement Plan (TSR), is available to Partner Physicians, Associate Physicians, and certain former Partner Physicians. You can set aside up to 75% of your eligible earnings or compensation each pay period on a pre-tax or after-tax basis up to the annual maximum limit. The 401(k) Plan provides a wide choice of investment options.

• SCPMG Early Separation Program (ESP), formerly known as the Full Early Retirement Program, which is available to all Partner Physicians from ages 58 through 65, may provide a temporary annuity until you reach age 65.

The remander of this section of the Handbook provides a summary of each of the SCPMG-sponsored retirement plans for physicians—Keogh Plan, 401(k) Plan, and ESP.

The Employee Retirement Income Security Act of 1974 (ERISA) governs the Keogh Plan and 401(k) Plan. For these plans and other SCPMG benefit plans governed by ERISA, this Benefits Handbook serves as your Summary Plan Description (SPD). The terms and conditions of Keogh Plan and 401(k) Plan are specified in the official plan documents. In case of any omission or conflict between what is written in this SPD and in the official plan documents, the official plan documents always govern.



The ESP is not subject to ERISA. For ESP, in the case of any omission or conflict in this handbook, the official plan document, the SCPMG Partnership Agreement, the SCPMG Rules and Regulations, and the minutes of SCPMG’s Board of Directors and the minutes of the Medical Directors, as applicable, always govern.

SCPMG KEOGH PLAN

Introduction

As an SCPMG physician, you have a number of retirement plans available to you. This document summarizes the SCPMG Keogh Plan, also referred to as the Keogh Plan.

The Keogh Plan is available to Partner Physicians, certain Partner Emeriti, and Business Administrators. The Keogh Plan is designed to allow eligible participants to make pre-tax contributions to a retirement plan and to allow the funds to accrue tax deferred earnings until distributed from the plan. These pre-tax contributions are made through convenient payroll deductions or, for full-year Partner Physicians, through lump sum contributions to the Keogh Plan.

The Employee Retirement Income Security Act of 1974, as amended, (ERISA) governs the Keogh Plan. This document serves as your Summary Plan Description (SPD) for the Keogh Plan. The terms and conditions of the Keogh Plan are specified in the official plan documents. In case of any omission or conflict between what is written in this SPD and in the official plan documents, the official plan documents always govern.

This plan is a qualified defined contribution plan which is designed to qualify for certain tax advantages under Internal Revenue Code (IRC) Section 401(a).

Eligibility

Eligibility for physicians is limited to eligible Partner Physicians and certain Partner Emeritus enrolled in the Keogh Plan at the time of retirement. The following SCPMG employees are also eligible to participate: the Chief Financial Officer, SCPMG; the Chief Quality Officer, SCPMG; and the Chief Operating Officer, SCPMG (collectively referred to as the Business Administrators).

If you are a Partner Physician, you are eligible on the later of:

• the date you become a Partner Physician or

• when you complete two years of service



If you are a Business Administrator, you are eligible on the later of:

• the date effective for your position or

• when you complete two years of service

In certain cases, former Partner Physicians continuing to work as a Partner Emeritus are eligible to participate in the Keogh Plan.

Electing to Participate in the Keogh Plan

This section describes general rules for electing to participate in the Keogh Plan that are applicable to most physicians. There are special rules for participating in the Keogh Plan for Partner Emeriti, Business Administrators and physicians who were previously eligible for another SCPMG retirement plan. These special rules are described after this section.

As a physician, you are generally eligible to begin contributing to the Keogh Plan upon becoming a Partner Physician. However, your decision to participate in the Keogh Plan must generally be made as an Associate Physician. However, if you were hired as Per Diem Physician before becoming an Associate Physician, your decision to participate in the Keogh Plan may be made before you become an Associate Physician.

As an eligible Associate Physician with SCPMG, to participate in the Keogh Plan, you must make an election to participate before your enrollment period ends. Generally, you will receive materials that will include a Keogh Plan Enrollment Guide booklet. You must either enroll online or return the signed enrollment form to Schwab Retirement Plan Services, Inc. (also referred to as Schwab in this SPD). Do not return your enrollment form to SCPMG. Only Schwab may accept enrollment forms.

Important Note: If you do not receive your enrollment materials shortly after you become an Associate Physician (or if earlier, after you are hired as a Per Diem Physician), you should contact Schwab at 1-888-256-8830.

Your Keogh Plan enrollment period generally ends just before you first become eligible to participate in the SCPMG Physicians’ 401(k) Plan.

The following Keogh Plan enrollment rules generally apply:

• if you were originally hired into SCPMG as an Associate Physician, you may enroll in Keogh Plan at any time during your first 180 days of employment at SCPMG.

• if you were originally hired into SCPMG as a Per Diem Physician, your decision to participate in the Keogh Plan must be made during your enrollment period as described below.

The Keogh Plan election deadline depends on whether you had:

• 6 months or more of service at SCPMG as a Per Diem Physician at the time of your transfer to Associate Physician or

• less than 6 months of service at SCPMG as a Per Diem Physician at the time of your transfer to Associate Physician.



6 Months or More of Service as a Per Diem Physician

If you had 6 or more months of service as a Per Diem Physician at the time of transfer and transferred to an Associate Physician from:

• January through June 30, then you will have 180 days from your date of transfer to Associate Physician to elect to contribute to the Keogh Plan or

• July 1 through December 31, then you will have until December 31 of the year of the transfer to Associate Physician to elect to contribute to the Keogh Plan.

Less than 6 Months of Service as a Per Diem Physician

In some cases, a Per Diem Physician may transfer to an Associate Physician with fewer than 6 months of service as a Per Diem Physician. In this case, you should contact Schwab at 1-888-256-8830 to determine your Keogh Plan election deadline.

Rehired Physicians

If you were hired as a Per Diem or Associate Physician, you leave SCPMG, and you are rehired, special rules apply in your case, so call Schwab immediately after your rehire at 1-888-256-8830 to determine your Keogh Plan election deadline.

Important Reminders on Keogh Plan Elections

After the Keogh Plan election period, your election to participate (or not participate) is irrevocable and cannot be changed for any reason.

Electing to participate in the Keogh Plan means that you are making an irrevocable commitment to make an annual contribution of the amount required for your selected level of participation, if and when you become a Partner Physician of SCPMG. Your participation will continue until you are no longer in an eligible category.

Missing the Keogh Plan election deadline means you elected not to contribute to the Keogh Plan. This decision cannot be changed in the future. Contact Schwab if you have any questions at 1-888-256-8830.

• Critical Deadline Reminder: Given the strict eligibility rules for the Keogh Plan, if you are hired as a Per Diem Physician, it is important to have your Keogh Plan election on file while you are a Per Diem Physician. If you wait until you are hired as an Associate Physician, you may miss your enrollment period.

• To ensure your Keogh Plan election is on file before your election deadline, you should contact Schwab at 1 888 256-8830 to verify your Keogh Plan election is on file.

Having a Keogh Plan election on file provides no guarantee that you will become a Partner Physician with SCPMG. Elections only apply if you become a Partner Physician and are eligible to make contributions under the Keogh Plan.



Partner Emeriti Participants

In many cases, Partner Emeriti (certain retired Partner Physicians who continue to work per diem post-retirement) who previously elected the Keogh Plan must continue making Keogh Plan contributions at the same level they were contributing prior to retirement (25%, 50%, 70% or 100%).

As a Partner Emeriti, you are not permitted to make Keogh Plan contributions post-retirement if you meet one of the following:

• retired prior to December 31, 2012

• retire on or after January 1, 2013, but experience a “separation from service” of 6 months or more (for more information on the meaning of “separation from service,” refer to the Administration of the Keogh Plan section of this SPD)

• retire on or after January 1, 2013 but did not previously contribute to the Keogh Plan.

In addition, when making Keogh Plan contributions, a Partner Emeriti cannot make lump sum contributions. Instead, the Partner Emeriti must contribute to the Keogh Plan through payroll deductions.

Business Administrators and Physicians Who Were Previously Eligible for Another SCPMG Retirement Plan

If you are a Business Administrator or if you are an Associate or Partner Physician who was previously eligible for another SCPMG retirement plan (for example, you were previously employed at SCPMG as a salaried employee and you were eligible for salaried retirement benefits and you are now an Associate Physician), then you do not make an election to participate in the Keogh Plan. Rather, your participation in the Keogh Plan is mandatory and automatic.

CONTRIBUTIONS

Your Contributions to the Keogh Plan

Your Keogh Plan contributions each year are based on the following formula:

Your Keogh Plan contribution level

X

The Keogh Plan contribution percentage

X

Your eligible earnings or eligible compensation, as applicable

=

Your Keogh Plan contributions



Each of these components of your Keogh Plan contributions are described below in more detail. In addition, Keogh Plan contributions are subject to federal tax limitations.

Your Contribution Level to the Keogh Plan

Eligible physicians have four Keogh Plan contribution levels from which to choose. You can generally choose to contribute 25%, 50%, 70% or 100% of the contribution percentage determined for the Keogh Plan each year. The contribution level you select at your election deadline (described above) in the Keogh Plan is irrevocable. You cannot change from one contribution level to another and you may not suspend contributions for any reason.

Exceptions: The Business Administrators participating in the Keogh Plan contribute at a rate equal to 70% of the contribution percentage determined each year. Physicians who were previously eligible for another SCPMG retirement plan contribute at a rate equal to 50% of the contribution percentage determined each year.

Your Contribution Percentage to the Keogh Plan

The contribution percentage determined for the Keogh Plan each year is the percentage of the Eligible Earnings paid to each participating Partner Physician (other than a Partner Emeriti) and the Eligible Compensation paid to each other participant.

Federal tax rules strictly limit annual contributions to the Keogh Plan. As a result, contributions to the Keogh Plan formula are calculated by an outside actuarial firm. This process produces a contribution percentage that changes from year to year. In no event will the contribution level for a year exceed 15% of your Eligible Earnings or Eligible Compensation (as applicable) for that year.

Eligible Earnings or Eligible Contributions

Eligible Earnings for Partner Physicians

Your Keogh Plan Eligible Earnings is your net earned income from self-employment, which includes Imputed Income and your Year-End Performance Draw, adjusted to account for the deductions related to unreimbursed business expenses and self-employment taxes. Your contributions to the Keogh Plan are included in your Eligible Earnings for purposes of determining your annual contributions to the Keogh Plan.

Your Imputed Income generally includes the cost of medical, dental, disability and life insurance benefits paid by SCPMG on your behalf. Your Year-End Performance Draw is your share of the amount that is distributed among Partner Physicians at the end of the year, which is generally processed in March of the following year for the previous year.



Eligible Compensation for Partners Emeriti and Business Administrators

Eligible Compensation is generally your annual pay (with certain restrictions). Eligible Compensation will be reduced by your Keogh Plan contribution when reported on the Form W-2.

Federal Tax Limits on Your Keogh Contributions

Your retirement plans are subject to a variety of complex federal laws, including federal tax laws. The following are a few requirements applicable to your Keogh Plan.

Federal Tax Limits on Your Eligible Earnings or Eligible Compensation

The Internal Revenue Service (IRS) imposes annual limits on the maximum amount of earnings or compensation on which Keogh Plan contributions can be calculated. The limit is $280,000 for 2019. For Partner Physicians, the maximum amount is adjusted for unreimbursed business expenses and self-employment taxes.

Annual Maximum Contribution Limit - Coordination with the 401(k) Plan

In addition, under the tax laws, for each Plan Year, total combined contributions to a participant’s accounts under the SCPMG Physicians’ 401(k) Plan (401(k) Plan) and Keogh Plan (and any other SCPMG-sponsored qualified defined contribution retirement plans) cannot exceed the lesser of:

• 100% of the participant’s earnings or compensation for the Plan Year or

• the applicable IRS dollar limit for the Plan Year, which is $56,000 for 2019.

Contributions to your Keogh Plan and 401(k) Plan accounts may be stopped if your combined contributions reach the annual limit or may be refunded if your contributions exceed the annual limit.

How Contributions are Made

Keogh Plan contributions are based on your Eligible Earnings or your Eligible Compensation, as applicable. Keogh Plan contributions for Partner Physicians may be made by either payroll deduction or lump sum. Contributions for Partner Emeriti and Business Administrators are made through payroll deductions and lump sum contributions are not allowed.

You are always 100% vested in the total value of your Keogh Plan account.

Payroll Deductions

Under the payroll deduction method, a percentage will be determined each year that will be used to deduct contributions from your biweekly paychecks. These payroll deductions will generally begin automatically on the pay period in which you become eligible for the Keogh Plan.

Please note: Keogh Plan contributions are not deducted from the first paycheck of each year for Partner Physicians and Partner Emeriti.



If you are on a Military Leave of Absence, contributions to the Keogh Plan generally stop for as long as the leave continues. However, federal law provides rights to certain re-employed veterans for service credit and make-up contributions for all or a portion of your military service. Contact Schwab if you have any questions about how a Military Leave impacts your Keogh Plan contributions and rights under the Keogh Plan.

Contributions to the Keogh Plan will continue during your Extended Educational or Extended Medical Service Leave as long as you are receiving Eligible Earnings or Eligible Compensation, as applicable.

Lump Sum Contributions

Annual lump sum contributions are permitted for Partner Physicians and should be made before the second pay period of the new Plan Year. Lump sum contributions are not permitted from Business Administrators, Partner Emeriti, and Partner Physicians whose first-year contributions began mid-year.

If you are interested in making a lump sum contribution, special rules and instructions apply. Contact Schwab at 1-888-256-8830 for these rules.

Method to Obtain Maximum Contribution

Each pay period, your year-to-date earnings and year-to-date Keogh Plan contributions will be compared to help ensure that you have contributed your allowable maximum based on your elected contribution level.

Keogh Plan Catch-Up

If additional contributions are required, catch-up deductions will be taken. These additional deductions are known as Keogh Plan Catch-Up. The maximum Keogh Plan Catch-Up deduction permitted per pay period is $300 and will normally occur after the first pay period of the year, since Keogh Plan deductions are not taken from the first paycheck.

Year-End Processing

Once your Eligible Earnings or Eligible Compensation is known, it may be determined that an additional Keogh Plan contribution may be required.

For Partner Physicians, any necessary prior-year deductions will be taken from your final Partnership distribution or any other eligible compensation as determined by the Board of Directors.

If it is then determined that you have an additional amount to contribute for the previous year, that amount will be divided by the number of pay periods remaining prior to April 15, the tax deadline of the current year. These additional prior year contributions will be deducted in addition to your current year deductions.

If you over-contributed to the Keogh Plan for the year, the excess contribution will be refunded to you by April 15 of the following year.



INVESTMENTS

You can invest your Keogh Plan account among a diversified lineup of investment options. The investment options are reviewed by the SCPMG Retirement Committee on an ongoing basis, and the funds offered through the Keogh Plan are subject to change. A complete list of the funds is available online at schwabplan.com/scpmg.

You choose how you want your Keogh Plan account invested. You may invest each of your accounts in one or more of the investment options to meet your personal financial goals. You can change your investment elections as your needs change. Your fund elections will remain in effect until you make a change with Schwab.

Changes generally become effective the same business day if the change is made prior to 1 p.m. Pacific Time. If a change is made after 1 p.m. Pacific Time, the change will generally be effective the next business day.

If you do not provide Schwab with your investment elections, your contributions will automatically be deposited to the age-appropriate Vanguard Target Retirement Trust as determined by the year in which you turn age 65.

The Keogh Plan is intended to satisfy the requirements of Section 404(c) of ERISA and Department of Labor Regulation Section 2550.404c-1. In general, this means that you are solely responsible for any investment losses caused by your investment decisions. SCPMG, the SCPMG Retirement Committee, SCPMG’s directors, officers, Partner Physicians, employees, affiliates, plan fiduciaries, and the trustee do not guarantee or insure the performance of any of the investment funds offered by the Keogh Plan, and will not be liable for those losses. Because you alone are responsible for the losses or gains that result from your investment decisions, it is very important that you carefully consider the investment options available to you.

You should note that in the event that a proxy voting decision is required regarding shares of the investment funds, the investment fund shares will be voted by the SCPMG Retirement Committee in accordance with the guidelines for the Keogh Plan. The SCPMG Retirement Committee has established rules that prohibit certain investment elections that would generate taxable income for the Keogh Plan, causing the Keogh Plan to violate certain legal requirements or could result in a loss that exceeds your account. In the unlikely event you make this type of investment election, that election will not be implemented.

In addition, the Keogh Plan provides a variety of tools and services available to help make your investment and retirement decisions, such as the services available through Financial Engines. More information is available online at schwabplan.com/scpmg.



The SCPMG Retirement Committee is the plan fiduciary responsible for providing participants and beneficiaries with the information necessary for making informed decisions under the Keogh Plan. For more information, refer to the Claims, Appeals and Administrative Information section of this SPD.

You should note that your Keogh Plan account is not insured by the Pension Benefit Guarantee Corporation.

Published Investment Results

Monthly investment returns for the core funds are updated by the SCPMG Retirement Committee’s investment advisors.

Prospectuses are provided upon eligibility. If you would like a prospectus, fund fact sheet or a summary annual report on any of the investment funds, contact Schwab at 1-888-256-8830 or visit the Schwab website at schwabplan.com/scpmg.

Self-Directed Brokerage Accounts in the Keogh Plan

You may invest up to 99% of your Keogh Plan account in the Schwab self-directed brokerage account, the Personal Choice Retirement Account (PCRA). PCRA introduces a broader range of investment options than those offered in the Keogh Plan’s core funds. The Self-Directed Fund supplements your other Keogh Plan core investment options by providing access to certain individual securities such as stocks, bonds and mutual funds, as well as other types of investments.

PCRA is an optional account, and you may pay additional fees. For more information on charges, you may view the Self-Directed Brokerage Account fee comparison at schwabplan.com/scpmg. In addition, if you choose PCRA, you must complete an online PCRA application, available through your account at schwabplan.com/scpmg.

Your PCRA investments must comply with within the “approved investment” guidelines of the Keogh Plan. Go to the Schwab website at schwabplan.com/scpmg or the SCPMG Physician Portal at scpmgphysician.kp.org to access the Investment Policy Statement for more information.

In addition, if you choose to invest your Keogh Plan account in PCRA, you may not invest in any of the following:

• any interest in general partnerships

• non-registered or non-publicly traded securities (including restricted securities)

• derivatives, including commodity futures, forward contracts, uncovered call options, short put options and short sales

• foreign currencies and bank accounts



• non-tradeable Limited Partnerships

• Traded Limited Partnerships that report income via a K-1 and as a result could generate Unrelated Business Taxable Income (UBTI). These securities include Limited Partnerships and Royalty Trusts

• real estate

• oil, gas and mineral interests

• unsecured loans

• personal property (i.e. precious metals, gems, works of art, stamps, coins, collectibles, furniture and other household items, motor vehicles, etc.)

• stocks, bonds, notes or other securities or evidence of indebtedness issued or guaranteed by SCPMG or by any affiliated organization

• margin accounts

• Schwab debentures

This list may change from time to time so contact Schwab if you have questions.

In the event that there is any proxy voting decision with respect to any shares in your PCRA, you are responsible for making that decision.

Investment Transfers

Fund-to-Fund Transfers

Transfers between investment options are generally permitted daily. Requests made before 1:00 p.m. Pacific Time on a business day will usually become effective the same business day. You may transfer any whole percentage, or any dollar amount, of your investment fund balances to any other investment fund or funds.

PCRA Account Transfers

You may transfer any whole percentage or dollar amount of your PCRA cash balance to any other investment fund or funds. Securities must be liquidated and available in the cash account before all or a portion of your PCRA account may transfer to a core fund or funds.

Keogh Plan Account Fees

You pay the costs of administrative services for your Keogh Plan core fund account and PCRA. You can receive a copy of the fee schedules by contacting Schwab at 1-888-256-8830 or schwabplan.com/scpmg.

Account fees are deducted directly from your Keogh Plan account. Fees deducted from your account may include but not limited to recordkeeping fees; PCRA and other transaction fees, and trust services fees.



WITHDRAWALS, DISTRIBUTIONS AND ROLLOVERS

Keogh Plan In-Service Withdrawals

Prior to your termination from SCPMG, you may withdraw all or a portion of your Keogh Plan account in the following instances:

• After-tax account withdrawal – you may withdraw all or a portion of your after-tax account in the form of a lump sum (after-tax contributions were made prior to January 1, 1987).

• Rollover account withdrawal – you may withdraw all or a portion of your rollover account in the form of a lump sum.

• Disability – you may withdraw the portion of your Keogh Plan account balance as of December 31, 1993 (if applicable) if the Social Security Administration declares you eligible for Social Security disability income or you are approved for payment of benefit under a long-term disability plan maintained by SCPMG.

• Attainment of age 65 – you may request a one-time withdrawal of your Keogh Plan account when you turn age 65 and anytime thereafter. Payment can be processed in the form of a lump sum or fixed installments.

• Ceasing to be a Partner Physician – you may withdraw the portion of your Keogh Plan account as of December 31, 1993 (if applicable).

Loans and hardship withdrawals are not available under the Keogh Plan.

Distributions After Separation from Service from SCPMG

After you are no longer an active Partner Physician and you are no longer employed by SCPMG, you have separated from service from SCPMG. At that time, you may withdraw the portion of your Keogh Plan account balance as of December 31, 1993 (if applicable).

In order to receive a distribution of your contributions and any earnings in your Keogh Plan account on and after January 1, 1994, you must separate from service and meet one of the following eligibility requirements:

• you attain early retirement age, which occurs when you reach age 55 or older with 15 or more years of eligibility service or, alternatively, when your age plus years of eligibility service totals at least 75

• you reach normal retirement age, which is age 65

• you become disabled (as defined by the Social Security Administration) before you separated from service and you had at least 10 years of service

• you die



How Benefits Are Paid

The way your Keogh Plan benefits are paid depends on when payments are to begin and the type of benefit payment you choose. When you become eligible for a distribution of benefits, you may elect to receive the balance in your Keogh Plan account in any one of the following forms:

Lump Sum

You may receive all or any part of your account balance in a single payment in cash, in-kind (if available based on your investments in your account) or a combination of both.

If you are invested in the self-directed fund (the PCRA) and you elect lump sum payment, you may elect to receive your PCRA in cash, in-kind or a combination of both.

Monthly, Quarterly or Annual Installments

You may elect to receive payments in equal monthly, quarterly or annual installments over a period of at least two years, and no more than 25 years (or if less, your life expectancy at the time the election is made). The minimum monthly installment payment is $100. If you die before the entire account has been distributed, the remainder of the account balance will be paid to your beneficiary in a lump sum cash payment.

You may request a total or partial distribution of your remaining account balance at any time during the elected installment period in the form of a lump-sum cash payment.

If you have any nondeductible contributions in your account and elect installments, you may elect to receive your nondeductible contributions in a single sum with your first distribution payment rather than pro rata.

If you elect monthly, quarterly or annual installments, you may not revoke the election once payments begin. However, you may at any time request that all or part of the remaining installments be paid in a single payment.

If your account is $1,000 or less, the Keogh Plan will automatically distribute the account to you in a lump sum payment.

Your Keogh Plan balance will remain in the investment fund or funds of your choice until fully distributed.

When Payments Begin

If you are eligible for a distribution, payments will begin as soon as possible after you request a distribution. If you do not request a distribution after you are eligible to receive payments, distribution of your account will be deferred. You may defer receiving your distribution generally until as late as April 1 following the year in which you reach age 70½, at which time the Keogh Plan will automatically begin making minimum required distributions to you as required by the federal tax laws.



Important Exception: If you are still working for SCPMG as of January 1 of the year after the year in which you reach age 70½, payments will not be made to you until the first April 1 after the year in which you have separated from service with SCPMG.

Payment at Your Death

If you die before payments under the Keogh Plan begin and your beneficiary is your spouse, your spouse may select any of the previously described forms of payment. If your beneficiary is not your spouse, your beneficiary will receive payment in a lump sum (subject to the distribution rules outlined below).

All distributions to beneficiaries are subject to the following additional restrictions:

• If your beneficiary is not your spouse, your account balance shall be paid as soon as practicable after the later of the date SCPMG receives notification of your death or the date SCPMG receives a completed set of all required forms.

• If your beneficiary is your spouse, your surviving spouse may elect to have payments begin immediately, or, if your account balance is more than $1,000, he/she may defer payment to later date, but no later than April 1 following the year in which you would have attained age 70½.

If no election is made, payments will automatically begin April 1 of the year following the year in which you would have attained age 70½.

If you are married, you should be aware that federal law requires your spouse to be the beneficiary in the event of your death, unless your spouse consents in writing to your election of another beneficiary. The consent must be witnessed by a Notary Public. If you are unable to locate your spouse, if he/she is legally incompetent, or if you are legally separated from your spouse, contact Schwab.

Taxes and Rollovers to Other Plans

How your benefits are taxed when they are distributed depends on several factors, including the tax laws in effect at the time of the distribution, your age and the circumstances under which they are paid. You should seek financial planning or professional tax advice when you are deciding when and how you will receive your benefits.

In general, the funds in your account will usually be taxable as income when they are paid.

Also, in certain circumstances, distributions before age 59½ may be subject to a 10% federal excise tax and a state excise tax. There are some exceptions. You should consult a tax adviser concerning the applicability of this tax to any distribution you may elect to receive prior to age 59½.

You may be able to avoid taxes on your distributions by rolling over part or all of your Keogh Plan balance to an individual retirement account (IRA) or to



another employer’s retirement plan. If you are entitled to a distribution that is eligible to be rolled over, the Keogh Plan will provide you with information about your rollover options.

There are many requirements and restrictions concerning rollovers that are not discussed here. Your Keogh Plan account can offer both legal and tax advantages. You should seek financial planning or professional tax advice when you are deciding when and how you will receive your benefits.

Rollover Contributions to Your Keogh Plan Account

You may be able to rollover your benefit under an IRA or another employer’s retirement plan directly to this Keogh Plan, subject to the plan administrator’s acceptance and to conditions imposed on transfers by the IRS. If you are interested in rolling over amounts to this plan, contact Schwab at 1-888-256-8830.

MISCELLANEOUS

Tax Liens, Divorce, Court Orders and Litigation

Because the Keogh Plan is a tax-qualified retirement plan, assignment of benefits is generally not permitted except in the case of a Qualified Domestic Relations Order (QDRO) or in the case of an IRS tax lien.

A Domestic Relations Order must meet the requirements of federal law before all or a portion of your Keogh Plan account can be allocated to an alternate payee. Model QDROs are available from Schwab.

The Keogh Plan will comply with a QDRO providing marital property rights to spouses, former spouses, or other payees. In the event of a QDRO, a former spouse or other dependent could receive a portion of your benefits, even if you continue working. A copy of the Keogh Plan’s QDRO procedures and QDRO model template is available from Schwab. There are additional fees associated with a QDRO.

Should the Keogh Plan receive a QDRO, litigation or court order that affects your benefits, Schwab will generally notify you and you may be restricted from taking an in-service withdrawal or a distribution from your Keogh Plan account while the court order or legal proceeding is pending.

Reports and Statements

Partner Physicians will receive a statement from SCPMG that shows the Keogh Plan contribution amount for the previous year. This statement will be included with the mailing of your Schedule K-1.

Participants in the Keogh Plan will receive a quarterly account statement from Schwab after the end of the quarter. You will receive an electronic statement, but you may elect to receive a statement in the mail at any time.



In addition, if you have a Schwab PCRA, you will receive statements that provide details on the activity in your account.

Errors, Claims and Limitation of Rights

If you believe that there was some type of error regarding your benefit under the Keogh Plan, you can file a claim with the plan administrator as described in the Claims, Appeals and Administrative Information section. That section summarizes the procedures for making claims and appealing denials of claims by the plan administrator. You must exhaust these administrative procedures before bringing a legal claim in court.

Any claim regarding failure to timely pay, in whole or in part, your account as of your benefit starting date must be filed within one year of your benefit starting date. In addition, any claim must be filed before the two-year anniversary of the earlier of the following dates: the date you receive written notice of the facts reflecting the error, the date you knew of the error or the date you should have known of the error.

Vesting

Vesting refers to your entitlement to a benefit under the Keogh Plan. Once you are vested, you are entitled to a distribution of your account once you leave SCPMG. Your Keogh Plan account is always 100% vested. This means that you are entitled to the total value of your contributions and any investment earnings in your Keogh Plan account when you leave SCPMG.

Unclaimed Benefits Process

You are responsible for maintaining your most current address on file with Schwab if you keep an account with them. If you cannot be located within 180 days of the latest date your benefit is required to be paid (for example, the date your account balance drops below $1,000 after you have left SCPMG), your account will be forfeited and used by the Keogh Plan. If you later return to claim your benefit, it will be deemed payable as of the required payment date.

Top-Heavy Rules

There are certain provisions that become effective if the Keogh Plan becomes “top-heavy” as defined by federal tax laws. A plan is considered top-heavy if benefit values for certain key participants exceed 60% of the value of all benefits for all plan participants. You will be notified if this occurs and if you are affected.



Effects on Other Benefits and Social Security

Participation in the Keogh Plan will not reduce your:

• FICA benefits (i.e., Social Security and Medicare benefits) or other age-based entitlements — they will be based on your full compensation and not the reduced amount.

• FICA or self-employment taxes, as applicable.

• Eligibility for other benefits offered by SCPMG that are calculated by reference to your annual earnings or compensation.

CLAIMS, APPEALS AND ADMINISTRATIVE INFORMATION

The Right to Amend or Terminate the Keogh Plan

At its sole discretion, SCPMG reserves the right to amend or terminate the Keogh Plan in any way and at any time. Such changes will be made in accordance with the procedures contained in the official plan document for the Keogh Plan.

General Information About ERISA Claims and Appeals

This section provides some general information that applies to claims for benefits under the Keogh Plan. It also provides additional information about filing claims and appeals for the following categories for benefits under the Keogh Plan.

Before you can file a civil action under ERISA section 502(a)(1)(B), you must meet any deadlines and exhaust the claims and appeals procedures set forth in this section. No legal action for benefits under Keogh Plan may be brought until the claimant has submitted a written claim for benefits in accordance with the procedures described below, has been notified by the plan administrator that the claim is denied, has filed a written appeal in accordance with the appeal procedures described below, and has been notified that all administrative remedies have been exhausted. If you miss a deadline for filing a claim or appeal, the claims administrator may decline to review it.

Use of an Authorized Representative

You may authorize a representative to help you pursue a claim or appeal on your behalf. Your representative need not be an attorney. Your representative may be asked to provide evidence that you have authorized him/her to represent you. Please let the claims administrator know if you would like responses to your claim or appeal to be sent directly to you instead of your authorized representative.



What is a Claim for Benefits

Federal law requires that a plan follow specific procedures when you make a claim for benefits or appeal a denial of your claim for benefits. A “claim” for benefits is a formal request by you (or your beneficiary) for the payment of benefits you believe are due under the terms of a benefit plan covered by ERISA.

You must submit in writing your claim for benefits or your appeal of a denial of a claim. You must submit your claim in the form and to the relevant person specified in this SPD. For example, it would not be a formal claim for benefits if you submitted your request for a benefit to your chief or the Board of Directors.

This section refers to “you” (i.e., the current or former physician) making a claim or appeal. If your beneficiary or an alternate payee is entitled to benefits under the Keogh Plan, generally claims may be made by a beneficiary or alternate payee and the same procedures will be followed as with a claim submitted by a physician.

The claims and appeals procedures described here do not apply to inquiries or requests that you might make about your plan benefits that are not formal claims for benefits. This means information provided in response to anything that fails to satisfy the requirements of a formal claim for benefits is not binding on the applicable plan and cannot be relied upon as the plan fiduciary’s response to your claim.

For example, the following are not formal claims for benefits:

• Questions you ask the Permanente Human Resources (PHR) Shared Services or any PHR staff member.

• Questions you ask a Schwab representative.

• Questions you ask Schwab’s call center.

• Your application to enroll in the Keogh Plan and other enrollment disputes. If you are denied the opportunity to enroll in the Keogh Plan because SCPMG or Schwab believe that you are not eligible to participate in the Keogh Plan at that time, then SCPMG or Schwab need not follow these claims and appeal procedures when responding to your challenge to that denial of coverage. However, if you believe that you are entitled to a benefit under the Keogh Plan and you submit a formal claim for benefits, the applicable procedures in this section will be followed, even if one of the issues is whether you are eligible to participate in the Keogh Plan or whether you properly enrolled in the Keogh Plan.

Information Provided by the Keogh Plan If Your Claim Is Denied

If the claims administrator denies your claim, then you will receive a written response from the claims administrator explaining the reasons for the denial. The deadlines for the claims administrator to inform you of a claim denial are summarized later in this section.



Your Right to Appeal a Denied Claim

Please refer to the information in this section for the deadline to file your appeal. If your appeal is not received by this deadline, then you may lose your right to the appeal and the benefit that you are seeking.

In connection with your appeal, you may make a written request for additional information and you will be provided, at no cost, reasonable access to and copies of all documents, records, and other information (other than legally privileged documents or information about other persons) relevant to your claim. As part of your appeal, you may submit written comments, documents, records, and other information relating to your claim for benefits, even if you did not submit this information in connection with your initial claim. Please address the concerns that were specified in the denial of your claim. Be sure to include any information and documents requested in the response to your claim. The Keogh Plan will review the appeal, taking into account all comments, documents, records, and other information submitted relating to the appeal, without regard to whether that information was submitted or considered in the initial review of your claim.

If the claims administrator denies your appeal, then you will be provided with a written response explaining the reasons for the denial.

If your appeal is denied and the claims administrator informs you that you have exhausted your administrative remedies, you can bring a civil action in federal court under Section 502(a)(1)(B) of ERISA. Unless otherwise provided in the appropriate plan document, any legal action must be brought in the U.S. District Court of the Central District of California and no legal action may be commenced or maintained against the Keogh Plan or the plan administrator more than 12 months from the date all administrative remedies under the Keogh Plan have been exhausted.

CLAIMS AND APPEALS

Claims for Keogh Plan Benefits

If you are a participant in the Keogh Plan and wish to receive a distribution of any account balance you have in the plan, contact Schwab online at schwabplan.com/scpmg or by calling Schwab Participant Services at 1-888-256-8830.

Schwab will mail you the appropriate distribution application forms upon request and will process your request for a distribution from the Keogh Plan. If you wish to contest the amount to be distributed to you, you may discuss it with a Schwab representative. If the problem is not resolved after discussing it with a Schwab representative, you may file a written claim with the SCPMG Retirement Committee (the plan administrator) at the address below.



Statute of Limitations

Any legal action must be brought in the U.S. District Court of the Central District of California. Any claim under the Keogh Plan must be filed with the plan administrator within 2 years following the earlier of the date you received written notice of the facts that give rise to the claim, or the date you knew or should have known about the claim. In addition, any claim regarding your form of payment or the failure to timely pay, in whole or in part, your account as of your benefit starting date must be filed within 1 year of your benefit starting date.

Deadlines for Responding to Your Claims

The claims administrator will make a decision on your claim within a reasonable period but not later than 90 days after it receives your written claim. In some cases, the claims administrator will notify you, before the end of the normal 90-day maximum period for responding to your claim, that additional time is required to process your claim on account of special circumstances. In that event, the claims administrator may take up to an additional 90 days to respond to your claim. When the claims administrator requests the 90-day extension, it will indicate the special circumstances and the date by which it expects to make a decision on your claim.

Appeal

Within 90 days from the date of the claim denial letter, you or your authorized representative may file an appeal by writing to the SCPMG Retirement Committee Appeals Sub-Committee (Appeals Sub-Committee) at the address below and request a review of the denial:

Southern California Permanente Medical Group SCPMG Retirement Committeec/o Permanente Human Resources 393 E. Walnut StreetPasadena, CA 91188-0001

Deadlines for Responding to Your Appeal

The Appeals Sub-Committee will review your appeal at the next regularly scheduled meeting following receipt of an appeal. If the appeal is not received at least 30 days prior to the next scheduled meeting, it may be heard at the following regularly scheduled meeting. Meetings are held quarterly, if needed. If special circumstances require a further extension of time for processing, a determination shall be rendered not later than the third regularly scheduled meeting after the receipt of the appeal. The Appeals Sub-Committee will advise you in writing within 5 days of its decision, citing the specific reasons for its decision, and will identify those terms of the Keogh Plan on which the decision is based.



Decision on Review

If the Appeals Sub-Committee denies your appeal, you will have exhausted your administrative remedies and you can bring a civil action in federal court under Section 502(a)(1)(B) of ERISA regarding the final denial of your claim for a benefit.

No legal action (whether in law, in equity, or otherwise) may be commenced or maintained against the Keogh Plan, the plan administrator, the SCPMG Retirement Committee, or its Appeals Sub-Committee more than one year after the later of the date of the initial claim denial, or if a timely request for appeal of the denial has been made, the date of the Appeals Sub- Committee’s appeal denial.

Leased Employee Service Claims

If you believe you may be entitled to service as a leased employee, please contact PHR Shared Services.

PHR Shared Services will provide you with a questionnaire to complete, along with an opportunity to submit evidence of your eligibility for such additional service. Examples of such evidence may include:

• W-2s for the years you worked for the leasing company for work performed at SCPMG

• An accounting report, your time card or an invoice from the leasing company reflecting the dates and total hours of work performed at SCPMG

Please note: your completed questionnaire may be subject to verification by SCPMG personnel, including any supervisor you may have reported to while working for the leasing company.

Additional evidence or clarification of your responses to the questionnaire may be required. The determination of whether you are entitled to service for periods of leased employment will be determined on a facts and circumstances basis.

You will receive a response, generally within 120 days, from PHR with a determination of your eligibility for additional service for all applicable benefit purposes. You will be notified if additional time is needed. If you disagree with the determination, you may file a written formal claim.

Important Note: If you intend to pursue a claim for benefits by filing a written formal claim, you must file the claim within 2 years of the date you were provided (or had access to) this plan’s Summary Plan Description.

Remember, first you need to seek a determination of your eligibility for additional service by submitting your completed questionnaire and evidence of your eligibility. If your claim for additional service as a leased employee is denied, you will have a chance to appeal the decision. In such cases, PHR will provide you with information and timelines on filing an appeal.



ADMINISTRATION OF THE KEOGH PLAN

Entity

Southern California Permanente Medical Group

Plan Sponsor

Southern California Permanente Medical Group393 E. Walnut St. Pasadena, CA 91188EIN # 95-1750445

Plan Administrator

SCPMG Retirement Committee393 E. Walnut St. Pasadena, CA 91188

Service of Legal Process

Service of legal process may be made upon a plan trustee or plan administrator. For the plan administrator, please direct all legal documents for service of legal process to the following agent:

Southern California Permanente Medical GroupAttn: Medical Director of Business ManagementWalnut Center393 E. Walnut St.Pasadena, CA 91188

Administrative Powers and Responsibilities

The plan administrator is the named fiduciary for purposes of ERISA that administers the Keogh Plan.

The plan administrator has the authority to administer the Keogh Plan and may delegate this authority to third parties, such as a committee. The plan administrator also may delegate its authority to approve or deny claims for benefits to a claims administrator. The plan administrator or, to the extent delegated to a third party, has the exclusive and full discretionary authority to control and manage the administration and operation of the Keogh Plan described in this SPD, including but not limited to the following:

• The discretionary authority to make and enforce rules for the administration of the Keogh Plan, including the designation of forms to be used in such administration.

• The discretionary authority to construe and interpret each and every document setting forth the applicable terms of the Keogh Plan.

• The discretionary authority to decide questions regarding the eligibility of any person to participate in any benefit plan.



• The discretionary authority to approve or deny claims for benefits the Keogh Plan unless discretionary authority has been delegated in writing to a third party.

• The discretionary authority to appoint or employ agents, including but not limited to, counsel, accountants, consultants and other persons to assist in the administration of the Keogh Plan.

Keogh Plan Information

The following is the plan name, identification number, and other relevant information for the Keogh Plan. The Keogh Plan Year ends December 31.

Plan Name

Plan SponorEIN # Sponsor

Plan No.

Type of Plan Claims Administrator

Type of Administration

Plan Trustee Funding Medium

Contribution Source

SCPMGKeogh Plan

95-1750445 9Sponsor

008 Tax-Qualified Defined Contribution Plan

SCPMG Retirement Committee

393 E. Walnut St.Pasadena, CA91188

Third-Party Administrator/Recordkeeper

Schwab Retirement Plan Services Inc.

c/o Participant Services SCPMGP.O. Box 816675Austin, TX 78708

Charles Schwab211 Main St.14th FLSan Francisco, CA94105

Trust Physician/Parricipant

Separation from Service

The Keogh Plan and the IRC require that there be a bona fide separation from service before there can be a distribution of your Keogh Plan benefits. This means that there can be no intent at the time of your separation (when you leave or retire from SCPMG) on either your part or that of your chief or other SCPMG personnel to re-employ you after you have taken a distribution of benefits or stopped your Keogh Plan contributions. This bona fide separation from service requirement means you may not leave with the intent to return as a physician, an employee or in such other capacities as consultant or contractor. This does not mean you may never return to SCPMG. You may return at some time in the future if you are applying for a bona fide open position. However, if you return, it must be because of changed circumstances after you terminate and retire, and not because of an agreement made prior to termination and retirement. Note: This paragraph does not apply if you are otherwise eligible for an in-service withdrawal under the Keogh Plan.



Recovery of Overpayments

To the extent that the Keogh Plan makes a payment to any participant or beneficiary in excess of the amount payable under the Keogh Plan to such participant or beneficiary, the Keogh Plan shall have a first right of reimbursement and restitution with an equitable lien by contract in the amount of such overpayment.

The holder of any such overpayment shall hold such property as the Keogh Plan’s constructive trustee. The Keogh Plan’s rights of reimbursement and restitution shall in no way be affected, reduced, compromised, or eliminated by any doctrines limiting its rights (equitable or otherwise) such as the make-whole doctrine, contributory or comparative negligence, the common fund doctrine, or any other defense. The Keogh Plan’s rights against the participant’s or beneficiary’s obligation to the Keogh Plan shall also not be affected if the overpayment was made to another person or entity on behalf of the covered individual or beneficiary.

If any participant or beneficiary has cause to reasonably believe that an overpayment may have been made, the participant or beneficiary shall promptly notify the plan administrator of the relevant facts, shall not alienate any property that may be subject to the Keogh Plan’s right of reimbursement or restitution, and shall cooperate with the Keogh Plan and take any action that may be necessary to protect the Keogh Plan’s interests as described in this SPD. If the plan administrator determines (on the basis of any relevant facts) that an overpayment was made to any participant or beneficiary (or any other person), any amounts subsequently payable as benefits under the Keogh Plan with respect to the participant or beneficiary may be reduced by the amount of the outstanding overpayment or the plan administrator may recover such overpayment by any other appropriate method that the plan administrator shall determine.

Nondiscrimination and Other Applicable Laws

Notwithstanding anything to the contrary in this SPD, the plan administrator may at any time modify any benefit or provision of any benefits to any extent the plan administrator believes necessary or appropriate to comply with any applicable nondiscrimination provisions of the IRC or any other applicable law.

Qualified Domestic Relations Order

In the event of a separation or dissolution of marriage, a court may issue an order directing the Keogh Plan to pay some or all of your retirement benefits for alimony, child support, or divided community property. Within a reasonable period after the Keogh Plan receives the order, it will determine whether the order is a QDRO and will advise you in writing of its determination, or it will ask a court to decide the question.

Until validity of the Domestic Relations Order is resolved, your interest in the Keogh Plan which is subject to the Domestic Relations Order will be



segregated and may not be distributed. If a decision is made within 18 months, the account will be paid out in accordance with the QDRO. If the status of the Domestic Relations Order is unresolved, your benefit will no longer be segregated, and distributions may be permitted. If the order is later determined to be qualified, the order will apply prospectively.

For additional information about a QDRO for your Keogh Plan benefits, including QDRO procedures and a model order that may assist you or your representatives in drafting a QDRO under the Keogh Plan, contact the following:

Charles Schwab4150 Kinross Lakes Parkway Richfield, Ohio 44286-5050 Attn: QDRO Review

If the Keogh Plan receives a Domestic Relations Order, you will be charged a processing fee that will be deducted from your account.

STATEMENT OF ERISA RIGHTS

As a participant in any benefit plan sponsored by SCPMG, you are entitled to certain rights and protections under ERISA. ERISA provides that all pension plan participants shall be entitled to:

• Examine, without charge, at the plan administrator’s office, copies of all documents filed by the Keogh Plan with the U.S. Department of Labor, such as detailed annual reports and plan descriptions.

• Obtain copies of all the Keogh Plan documents and other plan information upon written request to the plan administrator of the Keogh Plan. The plan administrator may make a reasonable charge for the copies.

• Receive a summary of the Keogh Plan’s annual financial report. The plan administrator is required to furnish each participant with a copy of the Summary Annual Report/annual funding notice free of charge.

• Prudent actions by plan fiduciaries. In addition to creating rights for plan participants ERISA imposes duties upon the people who are responsible for the operation of the benefit plan. The people who operate your Keogh Plan, called “fiduciaries” of the plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including SCPMG or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a pension benefit or exercising your rights under ERISA.

• If your claim for a pension or welfare benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.



Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report from the Keogh Plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the plan administrator to provide the materials and pay you up to $156 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court. In addition, if you disagree with the Keogh Plan’s decision or lack thereof concerning the qualified status of a domestic relations order, you may file suit in federal court. If plan fiduciaries misuse the Keogh Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.

Assistance with Your Questions

If you have any questions about the Keogh Plan, you should contact Schwab or PHR Shared Services. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the plan administrator, contact the U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-EBSA (3272), or the Division of Technical Assistance and Inquiries at the address below:

Division of Technical Assistance and Inquiries Employee Benefits Security AdministrationU.S. Department of Labor 200 Constitution Ave. NW Washington, D.C. 20210

You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.



SCPMG PHYSICIANS’ 401(K) PLAN

Introduction

As an eligible SCPMG physician, you have a number of retirement plans available to you. This document summarizes the SCPMG Physicians’ 401(k) Plan, also referred to as The 401(k) Plan for SCPMG and TSPMG (or the 401(k) Plan in this document) that applies to participants employed by SCPMG. The 401(k) Plan also covers eligible employees of TSPMG and a separate summary plan description applies to TSPMG.

The 401(k) Plan is available to Partners, Associate Physicians, and certain former Partners. You can set aside up to 75% of your eligible earnings or compensation on a pre-tax or after-tax basis up to IRS maximum limits. The 401(k) Plan provides a wide choice of investment options. The 401(k) Plan is designed to provide Partners, Associate Physicians, and certain former Partners who are working on a per diem basis with a means to accumulate retirement funds on a Traditional Pre-Tax, Roth 401(k) After-Tax or Traditional After-Tax basis.

The Employee Retirement Income Security Act of 1974 (ERISA) governs the 401(k) Plan. This document serves as your Summary Plan Description (SPD) for the 401(k) Plan. The terms and conditions of the 401(k) Plan are specified in the official plan documents. In case of any omission or conflict between what is written in this SPD and in the official plan documents, the official plan documents always govern.

This plan is a qualified defined contribution plan under Internal Revenue Code Sections 401(a) and 401(k). Traditional Pre-Tax and Roth 401(k) After-Tax contributions are also referred to as “401(k) deferrals.”

Eligibility

In many cases, you are eligible to participate in the 401(k) Plan after you have completed 180 days of service but in some cases, it may be longer, as described below. Generally, these special rules apply if you worked as a Per Diem before transferring to an Associate status or if you have been rehired.

The 401(k) eligibility rules for Associates are described in more detail below:

• If you were originally hired into SCPMG as an Associate Physician, you become eligible for the 401(k) Plan after completing your first 180 days of eligible service at SCPMG.

• If you were originally hired into SCPMG as a Per Diem Physician, when you become eligible for the 401(k) depends on whether you had:

– 6 months or more of service at SCPMG as a Per Diem Physician at the time of transfer to Associate Physician, or

– Less than 6 months of service at SCPMG as a Per Diem Physician at the time of transfer to Associate Physician.



6 Months or More of Service as a Per Diem Physician

If you had 6 or more months of service as a Per Diem Physician at the time of transfer and transferred to an Associate Physician from:

• January through June 30, then you will become eligible for the 401(k) Plan 180 days after the date of your transfer to Associate Physician.

• July 1 through December 31, then you will become eligible for the 401(k) Plan on January 1 of the year of following the year of your transfer to Associate Physician.

Less than 6 Months of Service as a Per Diem

In some cases, a Per Diem Physician may transfer to an Associate with fewer than 6 months of service as a Per Diem Physician. In this case, you should contact Schwab (sometimes also referred to Schwab Retirement Services, Inc. in this SPD) at 1-888-256-8830 to determine when you are eligible for the 401(k) Plan.

Rehired Physicians

If you were hired as a Per Diem Physician or Associate Physician, you leave SCPMG, and you are rehired, special rules apply in your case so call Schwab at 1-888-256-8830 immediately after you rehire to determine when you are eligible for the 401(k) Plan.

Former Partner Physicians

Former Partner Physicians continuing to work as a Partner Emeritus or a Per Diem Physician are eligible to participate in the 401(k) Plan. Per Diem Physicians who are not former Partner Physicians are not eligible to participate in the 401(k) Plan.

Enrollment

You may enroll at any time after you become eligible to participate in one of the following ways:

• Go to schwabplan.com/scpmg – you will need to register to establish your login ID and password before logging in.

• Call Schwab’s Participant Services at 1-888-256-8830.

During the enrollment process, you may have various options to consider, such as:

• Easy Enrollment – A 401(k) deferral rate of 15% is selected for you. You will be invested in an age appropriate Vanguard target date retirement fund.

• Self-Directed Enrollment – You select your preferred savings rate – any combination of Traditional Pre-Tax, Roth 401(k) After-Tax contributions, and Traditional After-Tax contributions - then select your 401(k) Plan investments.



The enrollment process may change from time-to-time so contact Schwab for more information.

CONTRIBUTIONS

Your Contributions to the 401(k) Plan

You may contribute from 1% – 75% (whole percentages only) of your eligible earnings or eligible compensation (as applicable) per pay period to the 401(k) Plan.

You may change your rate of contribution at any time. Your election to change or suspend contributions will be effective as soon as administratively possible as of the pay period following the processing of your request to the Recordkeeper, Schwab Retirement Plan Services, Inc.

For this purpose, your eligible earnings or eligible compensation generally includes the following:

• If you are a Partner, the amount of the net earnings the Partnership paid to you with respect to the plan year, including Supplementary Compensation (as defined in the Rules and Regulations of the Partnership) but excluding your imputed income on Partnership benefits.

• If you are an employee physician, the compensation paid to you by the Partnership for your employment, including any incentive payments and bonuses (with certain exceptions).

The following amounts are not eligible earnings or eligible compensation:

• Amounts paid or made available to you during the plan year while you were not working in a position eligible to participate in the 401(k) Plan.

• Moving expense reimbursements or payments.

• Amounts classified as special allowances.

• Distributions from non-qualified deferred compensation plans.

• Amounts in excess of the annual IRS compensation limit for the plan year (for 2019, this limit is $280,000).

• Due to laws regarding partnership tax accounting, contributions will not be taken from Year-End Performance Draw.

Types of 401(k) Plan Contributions

You may generally designate all or any part of your contributions to the 401(k) Plan as Traditional Pre-Tax, Roth 401(k) After-Tax, Traditional After-Tax contributions or a combination of all three.

Important: Determining which of these options makes the most sense for you will ultimately depend on several factors, including your federal and state tax rates when you eventually receive distributions from your 401(k) Plan account. You should consult with your financial planning or tax adviser on which options are best for you.



Traditional Pre-Tax Contributions

Your Traditional Pre-Tax contributions are made before taxes, reducing your current taxable income for income-tax purposes. The contributions and related earnings are not subject to income taxes until distributed to you from the 401(k) Plan.

Roth 401(k) After-Tax Contributions

Roth 401(k) After-Tax contributions are made on an after-tax basis. These contributions are included in your taxable income for the year the contribution is made; accordingly, the contributions are tax-free upon distribution. In addition, any earnings on your contributions are generally tax-free upon distribution if

• at least five years have passed since your first Roth 401(k) After-Tax contribution to the 401(k) Plan, and

• you have reached age 59½, you die, or you become disabled.

Traditional After-Tax Contributions

Traditional After-Tax contributions have similarities with Roth 401(k) After-Tax contributions but there are significant differences as well.

• Similar to Roth 401(k) After-Tax contributions, Traditional After-Tax contributions are made on an after-tax basis. This means that these contributions are included in your taxable income for the year the contribution is made. Accordingly, the contributions are tax-free upon distribution in both Roth 401(k) After-Tax contributions and Traditional After-Tax contributions.

• Different from Roth 401(k) After-Tax contributions

– You must complete two years of service at SCPMG to be eligible to make Traditional After-Tax contributions.

– If you elect Traditional After-Tax contributions as an Associate Physician, as soon as administrative possible after you become a Partner Physician, your Traditional After-Tax contributions will stop, and you must re-enroll if you would like to continue contributing on a Traditional After-Tax basis. To re-enroll, go to schwabplan.com/scpmg or call Schwab at 1-888-256-8830.

Important Planning Note: If you contribute to the Keogh Plan at the 100% contribution level as a Partner Physician, you may like to consider Traditional Pre-Tax 401(k) contributions or Roth 401(k) After-Tax contributions instead of Traditional After-Tax contributions. Contact Schwab for more information or consider consulting with your financial planning or tax adviser on which options are best for you.

– Any earnings on your Traditional After-Tax contributions are taxed as ordinary income upon distribution. In contrast, any earnings on Roth 401(k) After-Tax contributions will be tax free if you are at least 59½, you die, or you become disabled and you made your first Roth 401(k) After-Tax contributions at least five years earlier.



Roth Conversions

You also may be able to convert all or part of your Traditional Pre-Tax account balance to a Roth 401(k) After-Tax account through an In-Plan Roth conversion. You may convert any amount you wish and as many times as you wish, but you may do so only during periods you are eligible to make contributions to the 401(k) Plan. Once made, these conversions are irrevocable.

Your In-Plan Roth conversions will be includable in your taxable income for the year of the conversion; accordingly, the converted amounts are tax-free upon distribution. Generally, any earnings on the conversions are tax-free upon distribution if

• at least five years have passed since the relevant conversion date, and

• you have reached age 59½, you die or you become disabled.

Each In-Plan Roth conversion is subject to a separate five-year period.

Subject to IRS restrictions, your Traditional After-Tax account may also be converted to a Roth account through a conversion outside the 401(k) Plan.

For more information about Roth conversions, contact Schwab at 1-888-256-8830. Because of the tax consequences involved in Roth conversions, you should seek professional financial planning or tax advice when you are considering a Roth conversion.

Federal Tax Limits on Your 401(k) Contributions

Your retirement plans are subject a variety of complex federal laws, including federal tax laws. The following are a few requirements applicable to contributions to your 401(k) Plan account.

Annual 401(k) Limits (Applicable to Traditional Pre-Tax and Roth 401(k) After-Tax contributions)

The tax laws cap how much you may contribute in total on a Traditional Pre-Tax and a Roth 401(k) After-Tax basis to the 401(k) Plan for each Plan Year. For 2019, the limit is $19,000.

In addition, for any Plan Year in which you attain age 50 or older, you may make additional catch-up contributions to the 401(k) Plan. For 2019, the maximum catch-up contribution is $6,000 (for example, an eligible Physician who turns age 50 on December 31, 2019 may contribute up to $25,000 in 2019).

Catch-up contributions are made through payroll deductions just like your other 401(k) Plan contributions. This process is automatic. You will not need to make a separate enrollment election. That is, once your contributions to the 401(k) Plan reach the annual limit (i.e., $19,000 for 2019), your contributions will continue at the same contribution percentage rate you elected until you either reach the catch-up limit (an additional $6,000 for 2019) or elect to stop contributions.



If you do not want to make “catch-up” contributions, you may go online to schwabplan.com/scpmg and change your deferral election to “0” as of the date you reach your lower limit, or you may contact Schwab at 1-888-256-8830.

Annual Maximum Contribution Limit—Coordination with the Keogh Plan

Under the tax laws, for each Plan Year, total combined contributions to a participant’s accounts under the 401(k) Plan and Keogh Plan (and any other SCPMG-sponsored qualified defined contribution retirement plans) cannot exceed the lesser of

• 100% of the participant’s earnings or compensation for the plan year, or

• the applicable IRS dollar limit for the plan year, which is $56,000 for 2019.

Note, however, that age 50+ catch-up contributions do not count against the applicable IRS dollar limit.

Contributions to your Keogh Plan and/or 401(k) Plan accounts may be stopped if your combined contributions reach the annual limit or may be refunded if your contributions exceed the annual limit.

Discrimination Testing Limits

The amount you may contribute to the 401(k) Plan is subject to a federally required discrimination tests that apply to this type of plan. One of these complex tests compares the 401(k) deferrals of the “highly compensated” to the 401(k) deferrals of the “non-highly compensated” participants under all applicable 401(k) plans provided by SCPMG and may require a reduction in the 401(k) deferral percentages for the “highly compensated” participants. A similar but separate test compares the Traditional After-Tax contributions of the “highly compensated” to the Traditional After-Tax contributions of the “non-highly compensated” participants under all applicable plans provided by SCPMG and may require a reduction in the Traditional After-Tax deferral percentages for the “highly compensated” participants.

Because of these tests, Schwab or the plan administrator may inform you that your contribution percentage must be reduced, or that contributions may need to be refunded for a particular Plan Year.

INVESTMENTS

You can invest your 401(k) Plan account among a diversified lineup of investment options. The investment options are reviewed by the SCPMG Retirement Committee on an ongoing basis, and the funds offered through the 401(k) Plan are subject to change. A complete list of the funds is available online at schwabplan.com/scpmg.

You choose how you want your 401(k) Plan account invested. You may invest each of your accounts in one or more of the investment options to meet your personal financial goals. You can change your investment elections



as your needs change. Your fund elections will remain in effect until you make a change with Schwab. Changes generally become effective the same business day if the change is made prior to 1 p.m. Pacific Time and if a change is made after 1 p.m. Pacific Time the change will generally be effective the next business day.

If you do not provide Schwab with your investment elections, your contributions will automatically be deposited to the age-appropriate Vanguard Target Retirement Trust as determined by the year in which you turn age 65.

The 401(k) Plan is intended to satisfy the requirements of Section 404(c) of the Employee Retirement Income Security Act (ERISA) and Department of Labor Regulation Section 2550.404c-1. In general, this means that you are solely responsible for any investment losses caused by your investment decisions. SCPMG, TSPMG, the SCPMG Retirement Committee, SCPMG’s directors, officers, Partners, employees, affiliates, plan fiduciaries and the trustee do not guarantee or insure the performance of any of the investment funds offered by the 401(k) Plan and will not be liable for those losses. Because you alone are responsible for the losses or gains that result from your investment decisions, it is very important that you carefully consider the investment options available to you.

You should note that in the event that a proxy voting decision is required regarding shares of the investment funds, the investment fund shares will be voted by the SCPMG Retirement Committee in accordance with the guidelines for the SCPMG retirement plans. The SCPMG Retirement Committee has established rules that prohibit certain investment elections that would generate taxable income for the 401(k) Plan, cause the 401(k) Plan to violate certain legal requirements or could result in a loss that exceeds your account. In the unlikely event you make this type of investment election, that election will not be implemented.

In addition, the 401(k) Plan provides a variety of tools and services available to help you make your investment and retirement decisions, such as the services available through Financial Engines. More information is available online at schwabplan.com/scpmg.

The SCPMG Retirement Committee is the plan fiduciary responsible for providing participants and beneficiaries with the information necessary for making informed decisions under the 401(k) Plan. For more information, refer to the Claims, Appeals and Administrative Information.

You should note that your 401(k) Plan account is not insured by the Pension Benefit Guarantee Corporation.



Published Investment Results

Monthly investment returns for the core funds are updated by the Retirement Committee’s investment advisors.

Prospectuses are provided upon eligibility and are included in the enrollment packet. If you would like a prospectus, fund fact sheet, or a summary annual report on any of the investment funds, contact Schwab at 1-888-256-8830 or visit schwabplan.com/scpmg.

Investment Transfers

Transfers between investment options are generally permitted daily. Requests made before 1 p.m. Pacific Time on a business day will generally become effective the same business day. You may transfer any whole percentage, or any dollar amount, of your investment fund balances to any other investment fund(s).

401(k) Plan Account Fees

You pay the costs of administrative services for your 401(k) Plan account. You can receive a copy of the fee schedules by contacting Schwab at 1-888-256-8830 or schwabplan.com/scpmg. Account fees are deducted directly from your 401(k) Plan account.

Fees deducted from your account may include, but are not limited to, recordkeeping fees, transaction fees, loan fees and trust services fees.

LOANS, WITHDRAWALS, DISTRIBUTIONS AND ROLLOVERS

401(k) Plan Loans

Generally, you may borrow from your 401(k) Plan account by completing a loan application. There is a limit of one loan that you may have outstanding from your 401(k) Plan at one time.

Some Important Plan Loan Information

The following provides general information on limits applicable to 401(k) Plan loans:

• Each loan taken from the 401(k) Plan must be at least $1,000.

• The maximum loan available under the 401(k) Plan is equal to the lesser of:

– 50% of your 401(k) Plan account balance or

– $50,000 minus the highest outstanding loan balance from your 401(k) Plan account during the 12-month period preceding the day the new loan is to be made.

The interest rate for all loans is the prime rate +1%.



Repayment of Your Plan Loans

For participants who are actively working at SCPMG, loans are generally repaid by biweekly payroll deductions. For personal loans, the repayment period cannot exceed five years. For loans to purchase your primary residence, the repayment period cannot exceed 15 years.

Loans may be repaid in full at any time. Please contact Schwab Retirement Plan Services, Inc., Participant Services at 1-888-256-8830 to find out your payoff amount.

After you leave SCPMG (either due to retirement or separation), you may continue to make timely loan payments directly to Schwab. You may continue to repay a loan on a direct-billed basis as long as you defer receipt of your 401(k) Plan balance.

If you choose to receive a lump sum distribution before your loan is fully repaid, you will be required to repay the outstanding balance of your loan in full before the lump sum is paid. If you do not repay the loan before the lump sum payment is made or if you do not repay your loan when the payments are due, your loan will be defaulted. Special rules apply when 401(k) Plan loans are defaulted so contact Schwab at 1-888-256-8830 if you have any questions.

Additional rules apply. If you would like to borrow from your 401(k) Plan account or you would like additional details on 401(k) Plan loans, contact Schwab at 1-888-256-8830.

401(k) Plan In-Service Withdrawals

In addition to plan loans, your 401(k) Plan offers the following other opportunities for you to access your 401(k) Plan account while you are working at SCPMG or TSPMG.

Age 59½

While still working with SCPMG or TSPMG, you are permitted to take a withdrawal of any part of your 401(k) Plan account balance if you are age 59½ or older.

Hardship

In addition, while you are working with SCPMG or TSPMG, you may (regardless of your age) withdraw a lump sum amount from your 401(k) Plan account balance for certain hardship situations. Hardship withdrawals are permitted only from the portion of your 401(k) Plan balance that is attributable to your Traditional Pre-Tax 401(k) or Roth 401(k) After-Tax contributions.

Amounts available to be loaned from the 401(k) Plan and any other plans sponsored by SCPMG or TSPMG or any of their related organizations must be exhausted before a hardship withdrawal can be made. A



hardship distribution is allowed only if you certify that you have incurred an immediate and heavy financial need as defined by the IRS and the distribution is necessary to satisfy that need. Any money rolled over from another employer’s plan or a conduit IRA is not eligible for a hardship withdrawal.

You will only qualify for a financial hardship withdrawal if the financial need requires payment of the requested amount within 90 days or less.

You must certify that the hardship distribution is necessary because the financial need cannot be relieved through other resources. In making this certification, you are required to take into account any resources, including assets of your spouse and minor children that are reasonably available to you. A distribution will be treated as necessary to satisfy an immediate and heavy financial need if, and only if, the distribution is not in excess of the amount required to relieve the financial need, including taxes or penalties reasonably anticipated to result from the distribution.

Traditional After-Tax Account Withdrawals

You may withdraw all or a part of your Traditional After-Tax Account in the form of a lump sum at any time.

Rollover Account Withdrawals

You may withdraw all or a part of your Rollover Account in the form of a lump sum at any time.

Disability

Your 401(k) Plan account can be withdrawn upon your total and permanent disability. “Total and permanent disability” means that you have been declared by the Social Security Administration as eligible for disability income under Title II of the Social Security Act or that you have been declared eligible to receive long-term disability benefits under an SCPMG long-term disability plan.

To take any of these withdrawals or for more information, contact Schwab at 1-888-256-8830.

Distributions After You Terminate

Your 401(k) Plan account can be distributed in cash (or, in some instances, in-kind) when you are no longer employed by either SCPMG or TSPMG. Your 401(k) Plan account balance will be paid according to the benefit payment option you select, as described below.



How Benefits Are Paid

The following forms of benefit payment are generally available for all or any part of your 401(k) Plan account balance:

• Lump sum – you may request a lump-sum payment of all or any portion of your 401(k) Plan account balance.

• Monthly, quarterly or annual installments

– You elect to receive payments in equal monthly, quarterly, or annual installments over a period of at least 2 years and no more than 25 years (or if less, your life expectancy at the time the election is made). The minimum monthly installment payment is $100. If you die before the entire account has been distributed, the remainder of the account balance will be paid to your beneficiary in a lump sum.

– You may request a total or partial distribution of your remaining account balance at any time during the elected installment period in the form of a lump-sum payment.

– If you elect monthly, quarterly or annual installments, you may not revoke the election once payments begin. However, you may at any time request that all or part of the remaining installments be paid in a single payment.

If your account is $1,000 or less, the 401(k) Plan will automatically distribute the account to you in a single lump sum payment.

Your 401(k) Plan balance will remain in the investment fund(s) of your choice until fully distributed.

When Payments Begin

If you are eligible for a distribution, payments will begin as soon as possible after you request a distribution. If you do not request a distribution after you are eligible to receive payments, distribution of your account will be deferred. You may defer receiving your distribution until as late as April 1 following the year in which you reach age 70½, at which time the 401(k) Plan will automatically begin making minimum required distributions to you as required by the federal tax laws (except as noted in the next paragraph).

Important Exception: If you are still working for SCPMG or TSPMG as of January 1 of the year after the year in which you reach age 70½, payments will not be made to you until the first April 1 after the year in which you are no longer employed by either SCPMG or TSPMG.

Payment at Your Death

If you die before payment under the 401(k) Plan begins and:

• Your beneficiary is your spouse, your spouse may elect either a lump sum or installment payments (as described above), which will commence on the April 1 following the year that you would have reached age 70 ½, unless your spouse elects an earlier commencement date.



• Your beneficiary is not your spouse, your beneficiary will receive payment in a lump sum as soon as the 401(k) Plan receives the required forms.

If you die after payment under the 401(k) Plan has begun, and you have elected installment payments, the remainder of your account will be paid to your beneficiary in the form of a lump sum.

If you are married, you should be aware that federal law requires your spouse to be the beneficiary in the event of your death, unless your spouse consents in writing to your election of another beneficiary (or beneficiaries). The consent must be timely and witnessed by a Notary Public. If you are unable to locate your spouse, if he/she is legally incompetent, or if you are legally separated from your spouse, contact Schwab.

Taxes and Rollovers to Other Plans

How your benefits are taxed when they are distributed depends on several factors, including the tax laws in effect at the time of the distribution, your age, and the circumstances under which they are paid. You should seek professional financial planning or tax advice when you are deciding when and how you will receive your benefits.

Traditional Pre-Tax Contributions

In general, the Traditional Pre-Tax funds in your accounts will usually be taxable as income when they are paid. They may be subject to ordinary income tax, or you or your beneficiary may be eligible for certain special tax treatment, such as income averaging.

Roth 401(k) After-Tax Contributions

In general, the Roth 401(k) After-Tax contributions in your account were taxed at the time your contribution was made. Your Roth 401(k) After-Tax contributions are included in your taxable income for the year the contribution was made.

When you take a distribution, the portion of the distribution attributable to Roth 401(k) After-Tax contributions is nontaxable.

Generally, the portion of the distribution that represents earnings on Roth 401(k) After-Tax contributions will be tax free if you are at least 59½, you die, or you become disabled and you made your first Roth 401(k) After-Tax contributions at least five years earlier (or if the earnings are attributable to an In-Plan Roth conversion, the conversion occurred at least five years earlier).

Traditional After-Tax Contributions

In general, the Traditional After-Tax contributions in your account were taxed at the time your contribution was made. Your Traditional After-Tax contributions are included in your taxable income for the year the contribution was made.



When you take a distribution, the portion of your distribution attributable to traditional after-tax contributions is nontaxable. However, the portion of your distribution that represents earnings on traditional after-tax contributions will be taxable as ordinary income.

Additional Information

In certain circumstances, taxable distributions before age 59½ may be subject to an additional 10% federal excise tax and a state excise tax. There are some exceptions. For instance, under 2019 law, the federal excise tax will not be imposed if the distribution is due to death or total disability or is made on account of termination of SCPMG service at or after age 55. You should consult a tax adviser concerning the applicability of this tax to any distribution you may elect to receive prior to age 59½.

You may be able to avoid taxes on your distributions (or continue to receive tax-free earnings on your Roth 401(k) After-Tax contributions) by rolling over part or all of your 401(k) Plan balance to an individual retirement account (IRA) or to another employer’s retirement plan. If you are entitled to a distribution that is eligible to be rolled over, the 401(k) Plan will provide you with information about your rollover options.

There are many requirements and restrictions concerning rollovers that are not discussed here. In addition, the selection of your payment option can offer both legal and tax advantages. You should consult your financial planning or tax adviser before electing a payment option.

Rollover Contributions to Your 401(k) Plan Account

You may be able to rollover your benefit under an IRA or another employer’s retirement plan directly to this 401(k) Plan, subject to the plan administrator’s acceptance and to conditions imposed on transfers by the IRS. If you are interested in rolling over amounts to this plan, contact Schwab.

MISCELLANEOUS

Tax Liens, Divorce, Court Orders and Litigation

Because the 401(k) Plan is a tax-qualified retirement plan, assignment of benefits is generally not permitted except in the case of a Qualified Domestic Relations Order or in the case of an IRS tax lien.

A Domestic Relations Order must meet the requirements of federal law (or a Qualified Domestic Relations Order, also known as a QDRO) before all or a portion of your 401(k) Plan account can be allocated to an alternate payee. Model QDROs are available from Schwab.

The 401(k) Plan will comply with a QDRO providing marital property rights to spouses, former spouses or other payees. In the event of a QDRO, a former



spouse or other dependent could receive a portion of your benefits, even if you continue working. A copy of the 401(k) Plan’s QDRO procedures and QDRO model template is available from Schwab. There are additional fees associated with a QDRO.

Should the 401(k) Plan receive a Domestic Relations Order, litigation, or court order that affects your benefits, Schwab will generally notify you and you may be restricted from taking an in-service withdrawal or a distribution from your 401(k) Plan account while the court order or legal proceeding is pending.

Reports and Statements

Participants in the 401(k) Plan will receive a quarterly account statement from Schwab after the end of the quarter. You will receive an electronic statement, but you may elect to receive a statement in the mail at any time.

The quarterly statement of your account will provide you the details of the contributions made, as well as investment gains or losses and any fees associated with the 401(k) Plan. You generally bear the costs of maintaining your 401(k) Plan account. These costs may include recordkeeping fees, trustee fees, investment fees, loan fees and disbursement fees. These fees are described in the 401(k) Plan Fee Schedule, which you can obtain from Schwab.

Errors, Claims and Limitation of Rights

If you believe that there was some type of error regarding your benefit under the 401(k) Plan, you can file a claim with the plan administrator as described in the Claims, Appeals and Administrative Information section. That section summarizes the procedures for making claims and appealing denials of claims by the plan administrator. You must exhaust these administrative procedures before bringing a legal claim in court.

Any claim regarding failure to timely pay, in whole or in part, your account as of your benefit starting date must be filed within one year of your benefit starting date. In addition, any claim must be filed before the two-year anniversary of the earlier of the following dates: the date you receive written notice of the facts reflecting the error, the date you knew of the error, or the date you should have known of the error.

Vesting

Vesting refers to your entitlement to a benefit under the 401(k) Plan. Once you are vested, you are entitled to a distribution of your account once you are no longer employed by either SCPMG or TSPMG. Your 401(k) Plan account is always 100% vested. This means that you are entitled to the total value of your contributions and any investment earnings in your 401(k) Plan account when you are no longer employed by either SCPMG or TSPMG.



Unclaimed Benefits Process

You are responsible for maintaining your most current address on file with Schwab if you keep an account with them. If you cannot be located within 180 days of the latest date your benefit is required to be paid (for example, the date your account balance drops below $1,000 after you are no longer employed by either SCPMG or TSPMG), your account will be forfeited and used by the 401(k) Plan. If you later return to claim your benefit, it will be deemed payable as of the required payment date.

Top-Heavy Rules

There are certain provisions that become effective if the 401(k) Plan becomes “top-heavy” as defined by federal tax laws. A plan is considered top-heavy if benefit values for certain key participants exceed 60% of the value of all benefits for all plan participants. You will be notified if this occurs and if you are affected.

Effects on Other Benefits and Social Security

Participation in the 401(k) Plan will not reduce your:

• FICA benefits (i.e., Social Security and Medicare benefits) or other age- based entitlements — they will be based on your full compensation and not the reduced amount.

• FICA or self-employment taxes, as applicable.

• Eligibility for other benefits offered by SCPMG that are calculated by reference to your annual earnings or compensation.

Military Leave of Absence

Generally, if you are on a Military Leave of Absence, contributions to the 401(k) Plan stop for as long as the leave continues. However, federal law provides rights to certain re-employed veterans for service credit and make-up contributions for all or a portion of your military service. Special rules also apply if you have a plan loan that is outstanding during your Military Leave of Absence.

Please contact Schwab if you have any questions about how a Military Leave impacts your contributions and rights under the 401(k) Plan.

Extended Educational and Extended Medical Service Leaves

If you are on paid leave of absence, contributions will continue during your leave as long as you are receiving eligible earnings/compensation. Contributions will also continue for any period during which you are on a paid leave for full-time, formalized, and established medical service programs qualifying as an extended Medical Service Leave under the terms of the SCPMG Partnership Agreement and the SCPMG Rules and Regulations.




The Right to Amend or Terminate the 401(k) Plan

At its sole discretion, SCPMG reserves the right to amend or terminate the 401(k) Plan in any way and at any time. Such changes will be made in accordance with the procedures contained in the official plan document for the 401(k) Plan.


This section provides some general information that applies to claims for benefits under the 401(k) Plan. It also provides additional information about filing claims and appeals for the following categories for benefits under the 401(k) Plan.

Before you can file a civil action under ERISA section 502(a)(1)(B), you must meet any deadlines and exhaust the claims and appeals procedures set forth in this section. No legal action for benefits under the 401(k) Plan may be brought until the claimant has submitted a written claim for benefits in accordance with the procedures described below, has been notified by the plan administrator that the claim is denied, has filed a written appeal in accordance with the appeal procedures described below, and has been notified that all administrative remedies have been exhausted. If you miss a deadline for filing a claim or appeal, the claims administrator may decline to review it.


You may authorize a representative to help you pursue a claim or appeal on your behalf. Your representative need not be an attorney. Your representative may be asked to provide evidence that you have authorized him/her to represent you. Please let the claims administrator know if you would like responses to your claim or appeal to be sent directly to you instead of your authorized representative.

What is a Claim for Benefits?

Federal law requires that a plan follow specific procedures when you make a claim for benefits or appeal a denial of your claim for benefits. A “claim” for benefits is a formal request by you (or your beneficiary) for the payment of benefits you believe are due under the terms of a benefit plan covered by the Employee Retirement Income Security Act of 1974 (ERISA), as amended.

You must submit in writing your claim for benefits or your appeal of a denial of a claim. You must submit your claim in the form and to the relevant person specified in this SPD. For example, it would not be a formal claim for benefits if you submitted your request for a benefit to your chief or the Board of Directors.



This section refers to “you” (i.e., the current or former physician) making a claim or appeal. If your beneficiary or an alternate payee is entitled to benefits under the 401(k) Plan, generally claims may be made by a beneficiary or alternate payee and the same procedures will be followed as with a claim submitted by a physician.

The claims and appeals procedures described here do not apply to inquiries or requests that you might make about your plan benefits that are not formal claims for benefits. This means information provided in response to anything that fails to satisfy the requirements of a formal claim for benefits is not binding on the applicable plan and cannot be relied upon as the plan fiduciary’s response to your claim.


• Questions you ask the PHR Shared Services or any Permanente Human Resources staff member

• Questions you ask a Schwab representative

• Questions you ask Schwab’s call center

• Your application to enroll in the 401(k) Plan and other enrollment disputes. If you are denied the opportunity to enroll in the 401(k) Plan because SCPMG or Schwab believe that you are not eligible to participate in the 401(k) Plan at that time, then SCPMG or Schwab need not follow these claims and appeal procedures when responding to your challenge to that denial of coverage. However, if you believe that you are entitled to a benefit under the 401(k) Plan and you submit a formal claim for benefits, the applicable procedures in this section will be followed, even if one of the issues is whether you are eligible to participate in the plan or whether you properly enrolled in the plan

Information Provided by the Plan If Your Claim Is Denied

If the claims administrator denies your claim, then you will receive a written response from the claims administrator explaining the reasons for the denial. (The deadlines for the claims administrator to inform you of a claim denial are summarized later in this section.)


Please refer to the information in this section for the deadline to file your appeal. If your appeal is not received by this deadline, then you may lose your right to the appeal and the benefit that you are seeking.

In connection with your appeal, you may make a written request for additional information and you will be provided, at no cost, reasonable access to and copies of all documents, records, and other information (other than legally privileged documents or information about other persons) relevant to your claim. As part of your appeal, you may submit written comments, documents, records, and other information relating to your claim for benefits, even if you did not submit this information in



connection with your initial claim. Please address the concerns that were specified in the denial of your claim. Be sure to include any information and documents requested in the response to your claim. The plan will review the appeal, taking into account all comments, documents, records, and other information submitted relating to the appeal, without regard to whether that information was submitted or considered in the initial review of your claim.


If your appeal is denied and the claims administrator informs you that you have exhausted your administrative remedies, you can bring a civil action in federal court under Section 502(a)(1)(B) of ERISA. Unless otherwise provided in the appropriate plan document, any legal action must be brought in the U.S. District Court of the Central District of California and no legal action may be commenced or maintained against the plan or the plan administrator more than 12 months from the date all administrative remedies under the plan have been exhausted.

CLAIMS AND APPEALS

Claims for 401(k) Plan Benefits

If you are a participant in the 401(k) Plan and wish to receive a distribution of any account balance you have in the plan, contact Schwab online at schwabplan.com/scpmg or by calling Schwab Participant Services at 1-888-256-8830.

Schwab will mail (or otherwise provide) to you the appropriate distribution application forms upon request and will process your request for a distribution from the plan.

If you wish to contest the amount to be distributed to you, you may discuss it with a Schwab representative. If the problem is not resolved after discussing it with a Schwab representative, you may file a written claim with the SCPMG Retirement Committee (the plan administrator) at the address below.

Statute of Limitations

Any legal action must be brought in the U.S. District Court of the Central District of California. Any claim under the 401(k) Plan must be filed with the plan administrator within 2 years following the earlier of the date you received written notice of the facts that give rise to the claim, or the date you knew or should have known about the claim. In addition, any claim regarding your form of payment or the failure to timely pay, in whole or in part, your account as of your benefit starting date must be filed within 1 year of your benefit starting date.




The claims administrator will make a decision on your claim within a reasonable period but not later than 90 days after it receives your written claim. In some cases, the claims administrator will notify you, before the end of the normal 90-day maximum period for responding to your claim, that additional time is required to process your claim on account of special circumstances. In that event, the claims administrator may take up to an additional 90 days to respond to your claim. When the claims administrator requests the 90-day extension, it will indicate the special circumstances and the date by which it expects to make a decision on your claim.

Appeal

Within 90 days from the date of the claim denial letter, you or your authorized representative may file an appeal by writing to the SCPMG Retirement Committee Appeals Sub-Committee (“Appeals Sub-Committee”) at the address below and request a review of the denial:

Southern California Permanente Medical Group SCPMG Retirement Committeec/o Permanente Human Resources 393 E. Walnut StreetPasadena, CA 91188-0001


The Appeals Sub-Committee will review your appeal at the next regularly scheduled meeting following receipt of an appeal. If the appeal is not received at least 30 days prior to the next scheduled meeting, it may be heard at the following regularly scheduled meeting. Meetings are held quarterly, if needed. If special circumstances require a further extension of time for processing, a determination shall be rendered not later than the third regularly scheduled meeting after the receipt of the appeal. The Appeals Sub-Committee will advise you in writing within 5 days of its decision, citing the specific reasons for its decision, and will identify those terms of the plan on which the decision is based.

Decision on Review

If the Appeals Sub-Committee denies your appeal, you will have exhausted your administrative remedies and you can bring a civil action in federal court under Section 502(a)(1)(B) of ERISA regarding the final denial of your claim for a benefit.

No legal action (whether in law, in equity, or otherwise) may be commenced or maintained against the plan, the plan administrator, the SCPMG Retirement Committee, or its Appeals Sub-Committee more than one year after the later of the date of the initial claim denial, or if a timely request for appeal of the denial has been made, the date of the Appeals Sub- Committee’s appeal denial.



Leased Employee Service Claims

If you believe you may be entitled to service as a leased employee, please contact Permanente Human Resources (PHR) Shared Services.

PHR Shared Services will provide you with a questionnaire to complete, along with an opportunity to submit evidence of your eligibility for such additional service. Examples of such evidence may include:

• W-2s for the years you worked for the leasing company for work performed at SCPMG

• An accounting report, your time card or an invoice from the leasing company reflecting the dates and total hours of work performed at SCPMG

Please note: your completed questionnaire may be subject to verification by SCPMG personnel, including any supervisor you may have reported to while working for the leasing company.

Additional evidence or clarification of your responses to the questionnaire may be required. The determination of whether you are entitled to service for periods of leased employment will be determined on a facts and circumstances basis.

You will receive a response, generally within 120 days, from Permanente Human Resources with a determination of your eligibility for additional service for all applicable benefit purposes. You will be notified if additional time is needed. If you disagree with the determination, you may file a written formal claim.

Important Note: If you intend to pursue a claim for benefits by filing a written formal claim, you must file the claim within 2 years of the date you were provided (or had access to) this plan’s Summary Plan Description.

Remember, first you need to seek a determination of your eligibility for additional service by submitting your completed questionnaire and evidence of your eligibility. If your claim for additional service as a leased employee is denied, you will have a chance to appeal the decision. In such cases, Permanente Human Resources will provide you with information and timelines on filing an appeal.



ADMINISTRATION OF THE 401(K) PLAN

EntitySouthern California Permanente Medical Group

Plan SponsorSouthern California Permanente Medical Group Walnut Center 393 E. Walnut St. Pasadena, CA 91188 EIN # 95-1750445

Plan AdministratorSouthern California Permanente Medical Group SCPMG Retirement Committee 393 E. Walnut St. Pasadena, CA 91188



Southern California Permanente Medical Group Attn: Medical Director of Business Management Walnut Center393 E. Walnut St.Pasadena, CA 91188


The plan administrator is the named fiduciary for purposes of the Employee Retirement Income Security Act of 1974 (ERISA) that administers the 401(k) Plan.

The plan administrator has the authority to administer the 401(k) Plan and may delegate this authority to third parties, such as a committee. The plan administrator also may delegate its authority to approve or deny claims for benefits to a claims administrator. The plan administrator or, to the extent delegated to a third party, has the exclusive and full discretionary authority to control and manage the administration and operation of the 401(k) Plan described in this SPD, including but not limited to the following:

• The discretionary authority to make and enforce rules for the administration of the 401(k) Plan, including the designation of forms to be used in such administration

• The discretionary authority to construe and interpret each and every document setting forth the applicable terms of the 401(k) Plan



• The discretionary authority to decide questions regarding the eligibility of any person to participate in any benefit plan

• The discretionary authority to approve or deny claims for benefits the 401(k) Plan unless discretionary authority has been delegated in writing to a third party

• The discretionary authority to appoint or employ agents, including but not limited to, counsel, accountants, consultants and other persons to assist in the administration of the 401(k) Plan

401(k) Plan Information

The following is the plan name, identification number, and other relevant information for the 401(k) Plan. The 401(k) Plan Year ends December 31.

Plan Name

Plan SponorEIN # Sponsor

Plan No.

Type of Plan Claims Administrator


Plan Trustee Funding Medium

Contribution Source

SCPMGPhysicians’ 401(k) Plan

95-1750445 9Sponsor


SCPMG Retirement Committee

393 E. Walnut St.Pasadena, CA91188

Third-Party Administrator/Recordkeeper

Charles Schwab211 Main St.14th FLSan Francisco, CA94105

Trust Physician


The 401(k) Plan and the Internal Revenue Code (IRC) require that there be a bona fide separation from service before there can be a distribution of your 401(k) Plan benefits. This means that there can be no intent at the time of your separation (when you leave or retire from either SCPMG or TSPMG) on either your part or that of your chief or other SCPMG (or TSPMG, if applicable) personnel to re-employ you after you have taken a distribution of benefits. This bona fide separation from service requirement means you may not leave with the intent to return as a physician, an employee or in such other capacities as consultant or contractor. This does not mean you may never return to SCPMG or TSPMG. You may return at some time in the future if you are applying for a bona fide open position. However, if you return, it must be because of changed circumstances after you terminate and retire, and not because of an agreement made prior to termination and retirement. Note: This paragraph does not apply if you are otherwise eligible for an in-service withdrawal under the 401(k) Plan.




To the extent that the 401(k) Plan makes a payment to any participant or beneficiary in excess of the amount payable under the plan to such participant or beneficiary, the plan shall have a first right of reimbursement and restitution with an equitable lien by contract in the amount of such overpayment.

The holder of any such overpayment shall hold such property as the plan’s constructive trustee. The plan’s rights of reimbursement and restitution shall in no way be affected, reduced, compromised, or eliminated by any doctrines limiting its rights (equitable or otherwise) such as the make-whole doctrine, contributory or comparative negligence, the common fund doctrine, or any other defense. The 401(k) Plan’s rights against the participant’s or beneficiary’s obligation to the Plan shall also not be affected if the overpayment was made to another person or entity on behalf of the covered individual or beneficiary.

If any participant or beneficiary has cause to reasonably believe that an overpayment may have been made, the participant or beneficiary shall promptly notify the plan administrator of the relevant facts, shall not alienate any property that may be subject to the Plan’s right of reimbursement or restitution, and shall cooperate with the Plan and take any action that may be necessary to protect the Plan’s interests as described in this SPD. If the plan administrator determines (on the basis of any relevant facts) that an overpayment was made to any participant or beneficiary (or any other person), any amounts subsequently payable as benefits under the plan with respect to the participant or beneficiary may be reduced by the amount of the outstanding overpayment or the plan administrator may recover such overpayment by any other appropriate method that the plan administrator shall determine.

Nondiscrimination and Other Applicable Laws

Notwithstanding anything to the contrary in this SPD, the plan administrator may at any time modify any benefit or provision of any benefits to any extent the plan administrator believes necessary or appropriate to comply with any applicable nondiscrimination provisions of Internal Revenue Code or any other applicable law.


In the event of a separation or dissolution of marriage, a court may issue an order directing the 401(k) Plan to pay some or all of your retirement benefits for alimony, child support, or divided community property. Within a reasonable period after the 401(k) Plan receives the order, it will determine whether the order is a Qualified Domestic Relations Order (QDRO) and will advise you in writing of its determination, or it will ask a court to decide the question.



Until validity of the Domestic Relations Order is resolved, your interest in the plan which is subject to the Domestic Relations Order will be segregated and may not be distributed. If a decision is made within 18 months, the account will be paid out in accordance with the QDRO. If the status of the Domestic Relations Order is unresolved, your benefit will no longer be segregated, and distributions may be permitted. If the order is later determined to be qualified, the order will apply prospectively.

For additional information about a QDRO for your 401(k) Plan benefits, including QDRO procedures and a model order that may assist you or your representatives in drafting a QDRO under the 401(k) Plan, contact the following:

Charles Schwab4150 Kinross Lakes Parkway Richfield, Ohio 44286-5050 Attn: QDRO Review

If the 401(k) Plan receives a Domestic Relations Order, you will be charged a processing fee that will be deducted from your account.

STATEMENT OF ERISA RIGHTS

As a participant in any benefit plan sponsored by SCPMG or TSPMG, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974, as amended (ERISA). ERISA provides that all pension plan participants shall be entitled to:

• Examine, without charge, at the plan administrator’s office, copies of all documents filed by the plan with the U.S. Department of Labor, such as detailed annual reports and plan descriptions.

• Obtain copies of all the 401(k) Plan documents and other plan information upon written request to the plan administrator of the 401(k) Plan. The plan administrator may make a reasonable charge for the copies.

• Receive a summary of the 401(k) Plan’s annual financial report. The plan administrator is required to furnish each participant with a copy of the Summary Annual Report/annual funding notice free of charge.

• Prudent actions by plan fiduciaries. In addition to creating rights for plan participants ERISA imposes duties upon the people who are responsible for the operation of the benefit plan. The people who operate your 401(k) Plan, called “fiduciaries” of the plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including SCPMG or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a pension benefit or exercising your rights under ERISA.




Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report from the 401(k) Plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the plan administrator to provide the materials and pay you up to $156 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court. In addition, if you disagree with the 401(k) Plan’s decision or lack thereof concerning the qualified status of a domestic relations order, you may file suit in federal court. If the plan fiduciaries misuse the 401(k) Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.


If you have any questions about the 401(k) Plan, you should contact Schwab or Permanente Human Resources (PHR) Shared Services. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the plan administrator, contact the U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-EBSA (1-866-444-3272), or the Division of Technical Assistance and Inquiries at the address below:


You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.



EARLY SEPARATION PROGRAM

The Early Separation Program (ESP), formerly known as the Full Early Retirement Program, is designed to allow eligible Partner Physicians from the ages of 58 through 65 an opportunity for early retirement. This program is separate and distinct from the Common Plan. The ESP is sponsored and its benefits are paid by SCPMG.

A summary of the rules of the ESP can be found in the ESP Summary Plan Explanation, which is incorporated into this Handbook by reference and may be found on the SCPMG Physician Portal at scpmgphysician.kp.org or by contacting Permanente Human Resources Shared Services.

You should note that the information provided below describing the ESP is simply a brief overview of the Summary Plan Explanation and of the official plan document.

The ESP is not subject to Employee Retirement Income Security Act of 1974 (ERISA), in the case of any omission or conflict in this handbook, the official plan document always governs.

Eligibility

Any Partner Physician is eligible who:

• is age 58 through 65

• has 10 years of qualifying service with SCPMG while working at least a 5/10 schedule (5 years of qualifying service in the case of a Partner Physician determined to be disabled)

• has obtained advance approval by the SCPMG Board of Directors to begin Early Separation payments

• has retired from the Partnership (per diem work is sometimes permitted)

• has signed a SCPMG agreement and

• is not receiving benefits under a SCPMG group disability insurance

Application and Approval Required

All applications for Early Separation must:

• be in writing

• be filed at least one year in advance of the requested retirement date

• be reviewed and approved by the SCPMG Board of Directors

The Board of Directors may proceed with one of the following:

• grant the request

• waive all or part of the one-year notification requirement

• delay the retirement for up to one additional year

Once the application is submitted, it is irrevocable.



Once the application is approved, you may not rescind or change the date of your retirement (which is also your withdrawal date from the Partnership) except upon written application to and approval by, the Board of Directors prior to the effective date of your retirement.

Benefit Amount

The amount is based on your years of credited service with SCPMG and your highest average monthly base compensation. Your benefit amount is equal to the total of:

• 2% of your highest average monthly base compensation multiplied by your years of SCPMG credited service up to 20 years

Plus

• 1% of your highest average monthly base compensation, multiplied by your years of SCPMG credited service in excess of 20 years

The benefit is generally paid monthly beginning within two months from your retirement date at the end of every month after your separation from service and continues until the end of the month in which you reach age 65 or die, whichever occurs first.

ESP benefits are paid after you separate from service and cannot be deferred until a later date. In addition, the ESP has no death benefit. Payments under the ESP end at the earlier of the end of month in which you either attain age 65 or your date of death.

Early Separation and Sick Leave

In the event of illness or injury beginning prior to the start of Early Separation, any available Sick Leave may be used and Early Separation delayed. Group disability insurance benefits and Early Separation payments cannot be received concurrently. You must return from leave due to disability before your ESP payments can begin.

Transferring to Partner Emeritus Status

If you retire from the Partnership, and continue to work for SCPMG at 45% or less of your final average hours (FAH), if approved, then you will receive the ESP benefit following your retirement from the Partnership. Contact KPRC at 1-800-721-3647 for information on your FAH.

There are strict rules when working after retirement that apply so be sure to carefully read the ESP Summary Plan Explanation if you are considering working for SCPMG after your retirement from the Partnership.

Taxes

ESP benefits are taxable as ordinary income and self-employment tax income and you will receive the appropriate tax form after the end of the year. If you reside outside of the state of California, you may be subject to California withholding. Please consult your tax adviser.



Program May Be Amended or Terminated

The SCPMG Board of Directors may amend, modify or terminate the program at any time. Generally, no amendment may reduce the benefits being paid to a retiree except in case of extreme financial circumstances, the dissolution of the Partnership, or if necessary to comply with any applicable law.

Other Early Separation Program Benefits

In addition to ESP, you may be eligible for other benefits for Early Separation retirees including the following.

Special eligibility rules and additional requirements may apply to these benefits so it is important that you carefully read the Leaving SCPMG section of this Handbook for to determine if you are eligible for these benefits.

• Kaiser Foundation Health Plan coverage (Senior Advantage at age 65) for the retired Partner Physicians and eligible dependents.

• Supplemental Medical coverage for the retired Partner Physicians and dependents, if you are eligible.

• Medicare Part B Premium Reimbursement Program when you attain age 65, if you are eligible and satisfy the rules applicable under this program.

• Optional Life Insurance to age 65 when Tapered Life begins, if you are eligible. Special rules apply.

• Retiree Life Insurance if you are eligible. Special rules apply.

PARTNER EMERITUS CATEGORY (Impact to Benefits)

Partner to Partner Emeritus

“Partner Emeritus” is the term used for Partner Physicians who retired under the Early Separation Program (ESP) or who retired in the year they turned 65. The “Partner Emeritus” title is bestowed in recognition of a Partner Physician’s years of distinguished service to SCPMG and the members served. The SCPMG Rules and Regulations governs this process. A physician who retires is no longer eligible to accrue time-off benefits (i.e. vacation, leaves, disability), even if working occurs after retirement date.

A Partner Emeritus who may be receiving benefits from the ESP will be paid in accordance with the program as outlined in the ESP. For example: a Partner Emeritus, who is receiving ESP benefits, is subject to a limited work schedule with SCPMG (not to exceed 45% of the Final Average Hours (FAH)). If a Partner Emeritus is required to work under the 45% FAH criteria, it is the physician’s responsibility to monitor the hours worked. Exceeding the 45% FAH threshold may result in loss of Early Separation benefits, and may require payment of substantial taxes and penalties from personal assets to the taxing authorities. There may also be Common Plan implications. Contact the Kaiser Permanente Retirement Center at 1-800-721-3647 for information on the Common Plan.



Partner to Partner Emeritus A (No Keogh Contributions)

A Partner Emeritus A does not contribute to Keogh.

A former Partner Physician will be classified as a Partner Emeritus A for two primary reasons:

• Partner Emeritus A has a gap of at least 6 months following separation or retirement from SCPMG to the day work begins as a Partner Emeritus. This is generally referred to as separation from service (or sometimes referred to as a “break in service.” Because of a 6 month separation service, a Partner Emeritus A is no longer eligible to contribute to the Keogh Plan. Refer to the Separation from Service section in the Claims, Appeals and Administrative Information section for important requirements related to separation from service.

• A Partner Emeritus A may also be a physician who never contributed to Keogh while a Partner Physician. That physician will not contribute to Keogh as Partner Emeritus A and does not need to have a six-smonth break in service.

Partner to Partner Emeritus K (Keogh Contributions)

A Partner Emeritus K continues to contribute to Keogh at the same level of contribution while a Partner Physician. A Partner Emeritus K is generally required to begin work no later than 6 months following separation or retirement from SCPMG, and must continue to contribute to the Keogh Plan at the level originally elected (either 25%, 50%, 70% or 100%).

Generally, a Partner Emeritus K with a separation from service of 6 months or more will no longer be eligible to contribute to the Keogh Plan and will be recategorized as a Partner Emeritus A. Refer to the Separation from Service section in the Claims, Appeals and Administrative Information section for important requirements related to separation from service.

Note: A former Partner Physician – who is not a Partner Emeritus and who is working on a per diem basis – is referred to as a “Per Diem Physician.” For example:

• A physician age 55 through 58 may be eligible for retiree medical and life insurance benefits and decide to retire before becoming eligible for the ESP. The physician would be classified as a Per Diem.

• A physician at age 45 terminated from the Partnership to pursue other interests but enjoyed the practice SCPMG and returns to work on a per diem basis. The physician would be classified as a Per Diem.

• A physician retires under the ESP or at age 65 but decides not to remain Board certified. The physician would be classified as a Per Diem.

Any Per Diem Physician who was a former Partner Physician may be eligible to continue participating in the 401(k) Plan.



Eligibility Criteria for Benefits

The chart below provides general guidelines on eligibility for select SCPMG benefit programs. Please note benefits for Per Diems Physicians may differ based on:

• Gap in service between being an Associate or Partner Physician

• Full-Time schedule vs Part-Time schedule (Final Average Hours)

• Criteria for receiving awards

SCPMG Benefit Partner to Per Diem Physician

Meets the eligibility requirements for retiree medical and life programs but not the eligibility requirements for the Early Separation Program

Partner Physician to Partner Emeritus A or K

Meets eligibility requirements for Early Separation or age 65 retirement

Health & Life Insurance

Retains retiree health and life insurance (if eligible)

Retains retiree health & life insurance (if eligible)

401(k) Plan May continue contributing to 401(k) Plan May continue contributing to 401(k) Plan

Keogh Plan If previously participating in Keogh Plan, all contributions cease

If previously participating in Keogh Plan, contributions continue when working as Partner Emeritus K unless break in service of 6 months or greater occurs -- in which case, the physician would no longer be eligible to contribute to the Keogh Plan

Sick Leave Eligible for California Paid Sick Leave (use of sick leave same as permitted by state law)

Eligible for California Paid Sick Leave (use of sick leave same as permitted by state law)

Early Separation Program (ESP)

Generally not eligible to collect ESP Physician may generally continue to collect ESP benefits as long as less than 45% of Final Average Hours are worked

Impact to SCPMG Physicians’ 401(k) Plan

Contributions and percentage changes are still permitted for accounts in the 401(k) Plan while in Partner Emeritus status. Distribution options are not impacted. For example, a physician may access their entire account balance at age 59½.

Impact to Common Plan

Following retirement, a Partner Emeritus may work any number of hours and collect their Common Plan Part I benefit. However, in order to collect a Common Plan Part II benefit, special rules apply. Refer to the Common Plan Summary Plan Explanation and contact the Kaiser Permanente Retirement Center at 1-800-721-3647 to determine the impact working after retirement may have on the payment of benefits. For planning purposes, this inquiry should be done no less than 14 months in advance of retirement. This will



allow each physician to have information on the maximum number of hours able to be worked following retirement, which can be used in discussions with the Chief and Area Medical Director on the availability of a Partner Emeritus position.

Impact to Early Separation Retirees

A physician may collect Early Separation Program (ESP) benefits as early as age 58, if approved by the Board of Directors. However, a physician collecting ESP benefits may only work up to 45% of Final Average Hours (FAH) worked in the 36 months immediately prior to retirement.

A physician working as a Partner Emeritus will be asked to sign a contract in agreeing to work up to a maximum of 45% FAH. If this percentage is exceeded, the physician will not be eligible to receive ESP benefits. The physician will also likely be required to pay severe taxes and penalties, and will forfeit any future ESP benefits while working over the allowable 45% FAH. Ultimately, it is the physician’s responsibility, not SCPMG’s, to monitor the number of hours worked.


LEAVING SCPMG

SECTION VII

250

LEAVING SCPMG 251SECTION: VII


LEAVING SCPMG

This section summarizes your benefits when you leave SCPMG due to retirement, termination, disability, or death. Refer to the Retiree Benefits Handbook for more information.

Health Care Benefits

Eligibility

To be eligible for health care benefits in retirement, a physician must:

• attain age 55 with 15 or more years of Qualifying Service or

• attain age 65 with at least 10 years of Qualifying Service or

• have age plus years of Qualifying Service equal 75 (with 10 years or more of Qualifying Service) or

• be approved for Early Separation

All ESP participants and Early Retirees are eligible for health plan benefits. However, ESP participants and Early Retirees are eligible for Supplemental Medical benefits only if they meet one of the age and years of service requirements indicated above. For example, an ESP participant age 58 with 10 years of Qualifying Service would be eligible for health plan benefits, but not for Supplemental Medical.

Health care and Supplemental Medical may be continued or the retired physician will be enrolled in the Comprehensive Medical Plan if living outside the Kaiser service area. All eligible dependents must be enrolled in the same program as the physician.

A physician who leaves SCPMG due to disability with at least five years of Qualifying Service, but not enough service for retiree benefits, will have health plan coverage continued for himself/herself and eligible dependents at SCPMG expense. Supplemental Medical coverage will cease.

Refer to the Retiree Benefits Handbook for more information.

Comprehensive Medical Plan

Retirees living outside of the Kaiser Permanente service area may be eligible for this benefit. It is not a substitute for KFHP for active physicians. Refer to the Retiree Benefits Handbook for more information.

Retiree Age 65 and Older

If you stop working on or after your 65th birthday, you are required to apply for Medicare A and B and enroll in Senior Advantage.



Your spouse should enroll in Medicare when he/she reaches age 65 unless you are still working regardless of your age. When you stop practicing with SCPMG, you and your spouse would then both enroll in Medicare and Senior Advantage. Your Senior Advantage benefits are identical to your benefits under KFHP.


Retire Due to Disability

If you leave SCPMG due to disability with at least five years of Qualifying Service, but not enough service for retiree benefits, you will have KFHP coverage continued for yourself and your eligible dependents at SCPMG expense. Supplemental Medical coverage will cease unless you meet one of the age and years of service requirements described above.

If you are eligible for Disability Retirement, you, your spouse/domestic partner and any eligible dependents will retain KFHP coverage as if you were an eligible retiree.

Supplemental Medical Coverage

If you meet one of the age and years of service requirements described above, you will have Supplemental Medical coverage in retirement.


Alternate Mental Health Coverage

This benefit ends on the last day of the month you retire, terminate, or die. It is not available when you leave SCPMG and may not be converted to an individual policy.

Dental Benefits

This benefit ends on the last day of the month you retire, terminate, or die. The Delta Dental plan does not offer dental coverage to individuals and cannot be converted to an individual policy. Conversion is available for DeltaCare USA and United Concordia dental coverage.

COBRA and Cal-COBRA

You and/or your dependents may be able to continue certain health care benefits described in this Handbook when you leave SCPMG. Refer to the individual health care benefits descriptions in the Health Care Benefits or Other Benefits sections of this Handbook for more details regarding COBRA and Cal-COBRA coverage.



Life Insurance

Retiree Life Insurance

Retiree life insurance benefits are provided when you leave SCPMG as an eligible retiree having met one of the above requirements for age and years of service. Refer to the Retiree Benefits Handbook for more information.

Conversion of Life Insurance

When you leave SCPMG, you will be offered the opportunity to convert your life insurance coverage amounts to individual policies (including your Permanente Provided Life, Optional Life or Spouse/Domestic Partner life insurance). You must apply for and pay the premium for your age and class of risk within 90 days after your termination date from SCPMG. Evidence of insurability will not be required. This may be advantageous if you have a medical condition that might preclude you from qualifying for an individual life insurance policy.

If you die during the 90-day conversion period, your beneficiary will receive the insurance amount, whether or not you applied for conversion coverage.

The conversion insurance may be a type of life insurance currently being offered for conversion by the insurance company at your age and in the amount requested. It may not be term insurance and it may not be for an amount greater than the life insurance benefits in force under the existing Policy. The conversion policy will not provide accident, disability or other benefits. You will receive a Notice of Conversion from PHR Shared Services when you lose any of your Permanente Provided or Optional Life Insurance. The types of policies available under conversion are determined by the insurance company and may change from time to time.

Portability of Life Insurance

Life Insurance Company of North America, a CIGNA company, will allow you to port some or all of your Permanente Provided Life, Optional Life, Disabled Physicians Life, or Spouse/Domestic Partner life insurance. You may either convert your insurance to a whole life policy (as mentioned above) or port it into a term life policy. The portability policy will be issued without proof of medical insurability. This may be advantageous if you have a health condition that could make it difficult to obtain individual coverage elsewhere, although the cost may be higher than a private policy obtained on your own.

The option to port all or a part of your life insurance extends to age 80 with a $500,000 insurance maximum above age 70.

A spouse/domestic partner under age 70 has the opportunity to port some or all of Spouse/Domestic Partner Insurance in the event eligibility is lost because the insured physician’s employment terminates or in the event the spouse/domestic partner no longer qualifies as your spouse/domestic



partner due to legal separation, divorce, or the physician’s death. A spouse/domestic partner who continues coverage through portability will be issued a separate certificate of insurance by CIGNA.

Portability to Term Life Option

Contact PHR Shared Services at 1-877-608-0044 to request an Application for Continuation of Term Life Insurance (Portability) and premium rate sheet. Application must be made within 90 days from the date you lose coverage. If you wish to exercise your portability option, request, complete and forward the application to: NEBCO, P.O. Box 152501, Irving, TX 75015. If you have any questions, you may contact NEBCO at 1-800-423-1282.

Benefits When You Leave SCPMG

The following tables provide a basic summary of benefits that are available to you when you leave SCPMG in a variety of circumstances, including retirement, separation, disability, or death. While this section provides information regarding benefits available when you retire, you should consult the Retiree Benefits Handbook for more information on retirement benefits.

Retiree Benefits information is also available on the SCPMG Retiree Website which can be accessed at scpmgretiree.kp.org.

Retirement from SCPMG may occur after you have turned at least age 55 and have met the eligibility requirements for one of the categories listed below:

Retiree Benefit Class Age at Retirement Years of Qualifying Service

Normal Retirement (Partner or Associate Physician)

Age 65 or older, or the end of the year in which you turn age 65

At least 10 years of Qualifying Service

Early Separation Program (Partner Physician only)

Between age 58 and 65 with SCPMG Board of Director’s approval

10 years or more of SCPMG Qualifying Service

Early Retirement (Partner or Associate Physician)

At least age 55 15 years or more of Qualifying Service or age plus Years of Service = 75

Early Retirement (Partner or Associate Physician)

Age plus Years of Service equals at least 75 10 years of Qualifying Service

If you do not meet any of the above criteria, contact PHR Shared Services at 1-877-608-0044 to determine if you are eligible for retirement benefits.



NORMAL RETIREMENT• Age 65 or year-end age 65 • Partner or Associate Physician

This chart is a summary of benefits available when you retire from SCPMG and are eligible for Normal Retirement. Details regarding each benefit may be found in this Handbook and/or the Retiree Benefits Handbook.

Benefit Highlights

Kaiser Foundation Health Plan (KFHP) Required to enroll in Senior Advantage at age 65 or when you stop working in a Partner or Associate Physician category

• Coverage continues for you up to age 65 or until you stop working• You are required to enroll in Senior Advantage when you turn age 65 AND stop working• Your spouse/domestic partner continues KFHP coverage until age 65, then he/she must

enroll in Senior Advantage• Your eligible dependents continue coverage until age 26 unless disabled and approved by

KFHP• Your dependents are eligible for COBRA when coverage ends

Special Dependent (KFHP) • Coverage may continue through direct billing when you retire• You may add new, eligible Special Dependent(s)

Comprehensive Medical* • You are required to elect this coverage if you reside outside of the KFHP service area (California) and wish to have health coverage; otherwise you may waive coverage

• Please note: if you move into the Comprehensive Medical plan you will not be eligible for the Supplemental Medical if you meet the retirement criteria.

Kaiser Permanente Multi-Site Plan (KPMP)*

• You are required to elect this coverage if you reside outside of California but within the service area of other Kaiser Permanente participating providers; otherwise you may waive coverage

• Dependent eligibility varies

Supplemental Medical* • Coverage continues for you and your spouse/domestic partner if you are enrolled in KFHP or Senior Advantage

• Coverage continues for your eligible dependents until age 26• Dependents eligible for COBRA when coverage ends

Medicare Part B Premium Reimbursement Program*

• You are eligible when you turn age 65 and are retired; your eligible spouse/domestic partner who is age 65 or older is eligible for participation in the program

• You and your eligible spouse/domestic partner will be reimbursed when you enroll in Senior Advantage AND assign your Medicare Part A and B to KFHP

Alternate Mental Health • Coverage ends upon retirement• You, your spouse/domestic partner, and eligible dependents are eligible for COBRA

coverage• Mental health care is available through KFHP or Senior Advantage

Dental • Coverage ends upon retirement• You, your spouse/domestic partner, and eligible dependents are eligible for COBRA

coverage• Dental coverage is available through Senior Advantage once you reach age 65

Short-Term Disability (Associate Physicians only)

• Coverage ends upon retirement

Compensation Continuance (Partner Physicians only)


Long-Term Disability Insurance • Coverage ends upon retirement

(continued)



Benefit Highlights

Optional Life Insurance • Coverage ends upon retirement• Conversion/portability available

Permanente Provided Life Insurance

• Coverage ends upon retirement• Conversion/portability available

Disabled Physicians Life Insurance

• Coverage ends when no longer Totally Disabled or on the date you turn age 65• Conversion/portability available

Spouse/Domestic Partner Life Insurance


Tapered Life Insurance* • Coverage may begin at age 65 if you are eligible, or when Optional Life is no longer maintained

• You must have enrolled in Optional Life prior to 1/1/1991 and meet a combined age and service requirements

• You may have Tapered Life OR Retiree Life, NOT both

Retiree Life Insurance* • Coverage of $50,000 begins when all above insurances end if you are not eligible for and/or enrolled in Tapered Life

• You can have Tapered Life OR Retiree Life, NOT both

Business Travel Accident Insurance

• Coverage ends upon requirement

Professional Liability Insurance • Coverage ends upon retirement or when you cease to perform medical services for KFHP members, whichever is later

Vacation Leave • Paid off for accrued balance

Educational Leave • Benefit ends upon retirement

Sick Leave • Benefit ends upon retirement

Flexible Spending Accounts• Dependent Care• Health Care • Commuter Choice Program

• Partner Physicians are not eligible• Associate Physician contributions cease upon retirement• In the year of retirement, an Associate Physician may request reimbursement for eligible

expenses incurred • Claims for the retirement year must be filed by 3/31 of the following year

Long-Term Care Insurance • If you are enrolled, the policy is portable; not provided by SCPMG• Payments are transferred to direct billing

Physician Work-Life Solutions • Coverage ends upon retirement• You and your family are eligible for COBRA

Voluntary Disability Program • Coverage ends upon retirement• May convert to Direct Billing. Consult with a financial planner

* To be eligible, you must be age 55 with 15 years of Qualifying Service, age 65 with 10 years of Qualifying Service; between age 58 and 65 with SCPMG Board of Director’s approval and 10 years of SCPMG Qualifying Service; or age plus years of Qualifying Service must equal at least 75 with 10 or more years of Qualifying Service.



EARLY SEPARATION PROGRAM• Only for Partner Physicians age 58 to age 64• Associate Physicians are NOT eligible

This chart is a summary of benefits available when you retire from SCPMG and are eligible for Early Separation. Details regarding each benefit may be found in this Handbook and/or the Retiree Benefits Handbook.

Benefit Highlights

Kaiser Foundation Health Plan (KFHP)* Required to enroll in Senior Advantage at age 65

• Your coverage continues until age 65 • At age 65, you are required to enroll in Senior Advantage• Your spouse/domestic partner continues KFHP coverage until age 65, then he/she must

enroll in Senior Advantage• Your eligible dependents continue coverage until age 26 unless disabled and approved by

KFHP • Your dependents are eligible for COBRA when coverage ends






Supplemental Medical* • Coverage continues for you and your spouse/domestic partner if enrolled in KFHP or Senior Advantage

• Coverage continues for eligible dependents until age 26• Dependents eligible for COBRA when coverage ends







coverage• Dental coverage is available through Senior Advantage once you reach age 65







(continued)




Benefit Highlights

Tapered Life Insurance* • Coverage can begin at age 65 if you are eligible, or when Optional Life is no longer maintained

• You must have enrolled in Optional Life prior to 1/1/1991 and meet a combined age and service requirements


Retiree Life Insurance* • Coverage of $50,000 begins when all above insurances end if you are not eligible for and/or enrolled in Tapered Life



• Coverage ends upon requirement





Long-Term Care Insurance • If you are enrolled, the policy is portable; not provided by SCPMG• Payments are transferred to direct billing






EARLY RETIREMENT • At least age 55 at least 15 years of CPQS; or• Age plus years of CPQS equal at least 75 with at least 10 years of CPQS

This chart is a summary of benefits available when you leave SCPMG due to Early Retirement. Details regarding each benefit may be found in this Handbook and/or the Retiree Benefits Handbook.

Benefit Highlights

Kaiser Foundation Health Plan (KFHP)*Required to enroll in Senior Advantage at age 65

• Your coverage continues until age 65 • At age 65, you are required to enroll in Senior Advantage• Your spouse/domestic partner continues KFHP until age 65, then he/she must enroll in

Senior Advantage • Your eligible dependents continue coverage until age 26 unless disabled and approved by

KFHP• Your dependents are eligible for COBRA when coverage ends






Supplemental Medical* • Coverage continues for you and your spouse/domestic partner if you are enrolled in KFHP or Senior Advantage

• Coverage continues for your eligible dependents until age 26• Dependents eligible for COBRA when coverage ends






Dental • Coverage ends upon retirement• You, your spouse/domestic partner, and eligible dependents are eligible for COBRA coverage• Dental coverage available through Senior Advantage once you reach age 65







(continued)




Benefit Highlights




• Not eligible



Tapered Life Insurance* • Coverage begins when Optional Life ends• You must have enrolled in Optional Life prior to 1/1/1991 and meet a combined age/service

requirement • You can have Tapered Life OR Retiree Life, NOT both

Retiree Life Insurance* • Coverage of $50,000 begins when all above insurance plans end if you are not eligible for and/or enrolled in Tapered Life









• Partner Physicians are not eligible• Associate Physician contributions cease upon retirement• In the year of retirement, an Associate Physician may request reimbursement for eligible

expenses incurred • Claims for the retirement year must be filed by 3/31 of the following year

Long-Term Care Insurance • If enrolled, your policy is portable; not provided by SCPMG• Payments are transferred to direct billing






DISABILITYThis chart is a summary of benefits available when you retire from SCPMG due to disability. Details regarding each benefit may be found in this Handbook.

Benefit Highlights

Kaiser Foundation Health Plan (KFHP) Required to enroll in Senior Advantage at age 65

• If you have at least 5 years of Qualifying Service, coverage continues until age 65• At age 65 you are required to enroll in Senior Advantage• If 5 years’ Qualifying Service requirement is not met, you and your spouse/domestic partner

and dependents may be eligible for COBRA or may convert to Personal Advantage

Special Dependent (KFHP) • You may continue coverage through direct billing • You may add new, eligible Special Dependent(s)• Coverage ends if you are ineligible and Special Dependents may convert to Personal

Advantage

Comprehensive Medical • If you have at least 5 years of Qualifying Service, you may choose this coverage in lieu of KFHP or Senior Advantage if you live outside of the KFHP service area

Kaiser Permanente Multi-Site Plan (KPMP)



Supplemental Medical* • Coverage continues for you and your spouse/domestic partner if enrolled in KFHP or Senior Advantage

• Coverage continues for your eligible dependents until age 26• You, your spouse/domestic partner, and your eligible dependents are eligible for COBRA

when coverage ends



• You and your eligible spouse/domestic partner will be reimbursed when you enroll in Senior Advantage AND assign your Medicare Part A and B to KFHP, Inc.

Alternate Mental Health • Coverage ends• You, your spouse/domestic partner, and eligible dependents are eligible for COBRA



coverage• Dental coverage available through Senior Advantage once you reach age 65


• Coverage for up to five months following disability


• Coverage ends

Long-Term Disability Insurance • Coverage up to age 65, if eligible

Optional Life Insurance • Refer to Disabled Physicians Life Insurance


• Refer to Disabled Physicians Life Insurance


• Coverage ends on the date you are no longer Totally Disabled or turn age 65• Conversion/portability available


• Coverage ends upon retirement or after 24 months of disability, whichever is first• Conversion/portability available

Tapered Life Insurance* • If you participated in Optional Life and are eligible, coverage begins when Disabled Physicians Life Insurance

(continued)



Benefit Highlights

Retiree Life Insurance* • Coverage begins if not eligible for Tapered Life if you meet the eligibility requirements


• Coverage ends

Professional Liability Insurance • Coverage ends upon disability or when you cease to perform medical services for KFHP, Inc. members, whichever is later


Educational Leave • Unused balance not compensable

Sick Leave • Unused balance not compensable


• Partner Physicians are not eligible• Associate Physician contributions cease at disability• In the year of disability, an Associate Physician can request eligible reimbursement for

expenses incurred while eligible• Claims for the disability year must be filed by 3/31 of the following year




* To be eligible, you must be age 55 with 15 years of Qualifying Service, age 65 with 10 years of Qualifying Service; bewteen age 58 and 65 with SCPMG Board of Director’s approval and 10 years of SCPMG Qualifying Service; or age plus years of Qualifying Service must equal at least 75 with 10 or more years of Qualifying Service.



TERMINATIONThis chart is a summary of benefits available when you are terminated from SCPMG. Details regarding each benefit can be found in the specific section of this Handbook.

Benefit Highlights

Kaiser Foundation Health Plan (KFHP)

• Coverage ends• Physician, spouse/domestic partner and dependents may be eligible to continue coverage

via COBRA or may convert to Personal Advantage

Special Dependent (KFHP) • Coverage ends • Special dependents may convert to Personal Advantage

Supplemental Medical • Coverage ends• You, your spouse/domestic partner, and dependents may be eligible to continue coverage

via COBRA

Alternate Mental Health • Coverage ends• You, your spouse/domestic partner, and dependents may be eligible to continue coverage

via COBRA

Dental • Coverage ends• You, your spouse/domestic partner, and unmarried dependents may be eligible to continue

coverage via COBRA


• Coverage ends


• Coverage ends

Long-Term Disability Insurance • Coverage ends

Optional Life Insurance • Coverage ends • Conversion/portability available


• Coverage ends • Conversion/portability available






• Coverage ends

Professional Liability Insurance • Coverage ends


Educational Leave • Cannot be used 90 days prior to termination• Unused balance not compensable



• Partner Physicians are not eligible• Associate Physician contributions cease at termination may be eligible to continue Health

Care FSA coverage via COBRA• In the year of termination, an Associate Physician may request eligible reimbursement for

expenses incurred while eligible• Claims for the termination year must be filed by 3/31 of the following year




DEATHThis chart is a summary of benefits available to your survivors when you die while actively employed at SCPMG. Details regarding each benefit can be found in the specific section of this Handbook.

Benefit Highlights

Kaiser Foundation Health Plan (KFHP) Required to enroll in Senior Advantage at age 65

• Coverage continues for your surviving spouse/domestic partner and eligible dependent children. At age 65, spousal coverage becomes Senior Advantage

• Coverage for spouse ends upon remarriage or entry into another domestic partnership; coverage for dependent children ends at age 26 unless disabled and approved by KFHP; spouse/domestic partner and dependents may be eligible to continue coverage via COBRA

Special Dependent (KFHP) • Special dependents may convert to direct bill or Personal Advantage

Comprehensive Medical • Your surviving spouse/domestic partner and eligible dependents are required to elect this coverage if you reside outside of the KFHP service area (California) and wish to have health coverage, otherwise you may waive coverage

Supplemental Medical • Coverage continues for your surviving spouse/domestic partner and eligible dependent children if you were retirement eligible at time of death

• Otherwise, your spouse/domestic partner and dependents may be eligible to continue coverage via COBRA

Medicare Part B Premium Reimbursement Program


• Your eligible spouse/domestic partner will be reimbursed when they enroll in Senior Advantage AND assign their Medicare Part A and B to KFHP

Alternate Mental Health • Coverage ends• Your spouse/domestic partner, and dependents may be eligible to continue coverage via

COBRA

Dental • Coverage ends• Your spouse/domestic partner, and unmarried dependents may be eligible to continue

coverage via COBRA

Short-Term Disability Insurance (Associate Physicians only)

• Coverage ends


• Coverage ends

Long-Term Disability Insurance • Coverage ends

Optional Life Insurance • If enrolled, life insurance proceeds paid to beneficiary(ies) on file


• If enrolled, life insurance proceeds paid to beneficiary(ies) on file


• If enrolled, life insurance proceeds paid to beneficiary(ies) on file




• If death while traveling on SCPMG business, insurance proceeds paid to beneficiaries on file for Optional and Permanente Provided Life

Professional Liability Insurance • Coverage ends


Educational Leave • Unused balance not compensable


(continued)



Benefit Highlights


• Partner Physicians are not eligible• Associate Physician contributions cease at death• In the year of your death, your estate can request reimbursement for eligible expenses

incurred while eligible• Claims for the year you are deceased must be filed by 3/31 of the following year

Long-Term Care Insurance • If enrolled, estate may be eligible for Return of Premium Upon Death provision

Physician Work-Life Solutions • Coverage ends• Your family members are eligible for COBRA

Voluntary Disability Program • Coverage ends



SECTION: VIII

266

CLAIMS, APPEALS AND ADMINISTRATIVE INFORMATION 267SECTION: VIII



The Right to Amend or Terminate the Plans

At its sole discretion, SCPMG reserves the right to amend or terminate any or all of the benefit plans described in this Handbook in any way and at any time. Such changes will be made in accordance with the procedures contained in the official plan documents for the plans subject to ERISA. For those benefit programs that are not subject to ERISA, such changes will be made in accordance with the procedures contained in plan documents, the SCPMG Partnership Agreement, SCPMG Rules and Regulations, the minutes of SCPMG’s Board of Directors and the minutes of the Medical Directors, as applicable.

Disputes for Benefit Plans Not Governed by ERISA

Certain benefit programs are not governed by ERISA, including but not limited to the Special Dependent Coverage, the Compensation Continuance Program, time-off benefits (including, the sick leave programs, vacation leave, annual education leave, holidays, compassionate leave, jury duty), other leaves of absence with or without payroll continuance benefits (such as, personal leave, family leave, military leave, and extended educational leave), the Commuter Choice Program, the Dependent Care Flexible Spending Account, the identity theft protection program, mortgage loan programs, student loan refinancing benefits, professional liability coverage, the Common Plan, and the Early Separation Program. The benefit programs not governed by ERISA may change from time-to-time. If you have questions on the current list of benefit programs not governed by ERISA, you may contact PHR Shared Services.

In the event of a dispute in a benefit program not governed by ERISA, contact PHR Shared Services since special rules may apply. For example, for some programs, such as the Early Separation Program, an official plan document or an agreement may govern disputes. However, in most benefit programs not governed by ERISA, the SCPMG Rules and Regulations govern disputes. In the event of any omission or conflict in the dispute resolution procedures for benefit plans not governed by ERISA, the plan document (if any), an agreement, the SCPMG Partnership Agreement, the SCPMG Rules and Regulations, and the minutes of SCPMG’s Board of Directors and the minutes of the Medical Directors, as applicable, always govern.

Note: The remainder of this Claims, Appeals and Administrative Information section applies to only to the benefit plans governed by ERISA.



Health and Welfare Eligibility and Enrollment Disputes

If you have a question relating to your or your dependent’s eligibility for health and welfare benefits, including enrollment disputes, you must contact PHR Shared Services. If you disagree with the response from PHR Shared Services, you may request an administrative review and submit a written dispute to PHR Shared Services.

Your request for an administrative review must be received by PHR Shared Services within 6 months of the event that gives rise to your initial question. PHR Shared Services will make a final determination regarding your inquiry within 90 days after the request for an administrative review is received.


This section provides some general information that applies to claims for benefits under various types of plans. It also provides additional information about filing claims and appeals for the following categories of plans and types of coverage:

• Health plans (i.e. medical plans, alternate mental health, dental plans, employee assistance program, and the Health Care Flexible Spending Account)

• Disability plans and other plans where benefits depend on whether you are disabled

• Retirement plans and retiree medical eligibility determinations

• Other plans subject to ERISA (i.e. life insurance plans, accidental death and dismemberment insurance plans, business travel accident insurance, long-term care insurance, etc.)

Before you can file a civil action under ERISA section 502(a)(1)(B), you must meet any deadlines and exhaust the claims and appeals procedures set forth in this section. No legal action for benefits under the plan may be brought until the claimant has submitted a written claim for benefits in accordance with the procedures described below, has been notified by the plan administrator that the claim is denied, has filed a written appeal in accordance with the appeal procedures described below, and has been notified that all administrative remedies have been exhausted. If you miss a deadline for filing a claim or appeal, the claims administrator may decline to review it.


You may authorize a representative to help you pursue a claim or appeal on your behalf. Your representative need not be an attorney. Your representative may be asked to provide evidence that you have authorized him/her to represent you. The fact that you assign your right to receive benefits to a health care provider does not, by itself, mean that you have



designated that health care provider as your representative. If your claim or appeal involves health benefits, then you (or the affected family member) may be asked to provide a written authorization that permits the health plan to provide personal health information to your representative. However, a licensed health care professional familiar with your medical condition may act as your representative with respect to a claim (or appeal) for urgent care without providing any further evidence that he/she is your representative. Please let the claims administrator know if you would like responses to your claim or appeal to be sent directly to you instead of your authorized representative.

What is a Claim for Benefits

Federal law requires that a plan follow specific procedures when you make a claim for benefits or appeal a denial of your claim for benefits. A “claim” for benefits is a formal request by you (or your beneficiary) for the payment of benefits you believe are due under the terms of a benefit plan covered by ERISA.

Except in the case of claims or appeals under a health plan involving urgent care, you must submit in writing your claim for benefits or your appeal of a denial of a claim. You must submit your claim to the relevant person specified in the “Claims and Appeals” section for each particular plan in this Handbook. For example, it would not be a formal claim for benefits if you submitted your request for a benefit to your chief or the Board of Directors. Similarly, refer to the specifics of each plan in this summary plan description (SPD) to find out if a particular form is required to submit a claim with respect to a specific plan.

This section refers to “you” (i.e. the current or former physician) making a claim or appeal. For plans that provide benefits to family members or beneficiaries, generally claims may be made by those family members or beneficiaries and the same procedures will be followed as with a claim submitted by a physician.

The claims and appeals procedures described here do not apply to inquiries or requests that you might make about your plan benefits that are not formal claims for benefits. This means information provided in response to anything that fails to satisfy the requirements of a formal claim for benefits is not binding on the applicable plan and cannot be relied upon as the plan fiduciary’s response to your claim. SCPMG (and not the plan fiduciary) may also have a separate administrative review process for resolving issues that are not formal claims for benefits.




• Questions you ask PHR Shared Services or any PHR staff member

• Questions you ask Schwab

• Questions you ask a claims administrator’s call center

• Your application to enroll in a physician benefit plan and other enrollment disputes. If you are denied the opportunity to enroll in a plan because SCPMG believes that you are not eligible to participate in that plan at that time, then SCPMG need not follow these claims and appeal procedures when responding to your challenge to that denial of coverage. However, if you believe that you are entitled to a benefit under one of the plans and you submit a formal claim for benefits, the applicable procedures in this section will be followed, even if one of the issues is whether you are eligible to participate in the plan or whether you properly enrolled in the plan

• Inquiries before a service is performed or a product is purchased as to whether a health plan will cover that service or product

• Your objections to a pharmacy about a problem when you attempt to fill your prescription at Kaiser Permanente or an outside pharmacy. If the pharmacy fails to provide you the medicine that you believe you are entitled to under the plan or charges you more than you believe is due under the terms of the plan, then you may file a claim for benefits and you will receive a response. The claim is filed with the person who handles claims for the medical or dental plan that will pay for the prescription, and not with the pharmacist

Information Provided by the Plan If Your Claim is Denied

If the claims administrator denies your claim, then you will receive a written response from the claims administrator explaining the reasons for the denial. (The deadlines for the claims administrator to inform you of a claim denial are summarized later in this section.) If your health plan claim for benefits is denied, then your Explanation of Benefits may serve as the written claim response. However, when responding to a health plan claim for urgent care, sometimes the claims administrator will communicate its decision orally so that you receive a faster response. The oral response will be followed up by a written response within 3 days after the oral response.

A denial of a claim may include any of the following responses: a failure to provide advance approval for a service (applies only when the plan requires pre-approval for the service); a failure to provide, in whole or in part, a particular service; a failure to pay, in whole or in part, for services that were performed; a reduction or termination of previously approved benefits; or a failure to provide, in whole or in part, a requested benefit pursuant to the terms of a specific plan.



The denial may be made for a variety of reasons such as the fact that the benefit is not covered by the plan, the amount claimed is excessive, or the fact that you are not covered by the plan.


Please refer to the information for each particular plan discussed in this section for the deadline to file your appeal. If your appeal is not received by this deadline, then you may lose your right to the appeal and the benefit that you are seeking.

In connection with your appeal, you may make a written request for additional information and you will be provided, at no cost, reasonable access to and copies of all documents, records and other information (other than legally or medically privileged documents or information about other persons) relevant to your claim. In some cases, you may be requested to obtain relevant records from your health care provider that the plan does not have. As part of your appeal, you may submit written comments, documents, records, and other information relating to your claim for benefits, even if you did not submit this information in connection with your initial claim. Please address the concerns that were specified in the denial of your claim. Be sure to include any information and documents requested in the response to your claim. The plan will review the appeal, taking into account all comments, documents, records, and other information submitted relating to the appeal, without regard to whether that information was submitted or considered in the initial review of your claim.


If your appeal is denied and the claims administrator informs you that you have exhausted your administrative remedies, you can bring a civil action in federal court under Section 502(a)(1)(B) of ERISA. Unless otherwise provided in the appropriate plan document, any legal action must be brought in the U.S. District Court for the Central District of California, and no legal action may be commenced or maintained against the plan or the plan administrator more than 12 months from the date all administrative remedies under the plan have been exhausted.

Health Plan Claims and Appeals

There are special rules that apply to claims and appeals for benefits under a health plan such as a medical plan, alternate mental health, a dental plan, employee assistance program, or the Health Care flexible spending account.



Types of Claims

The deadline for the claims administrator to respond to your claim or appeal depends on the type of claim you are making. Government regulations distinguish four different types of health plan claims and establish different rules for responding to these types of claims:

Urgent Care Claim: This is a claim in which you are seeking advance approval for urgent care. Urgent care is medical care or treatment for which a faster than normal decision on your claim or appeal is required to avoid seriously jeopardizing your life, health or ability to regain maximum function. Urgent care is also care that, in the opinion of your physician who is familiar with your medical condition, is needed to prevent you from suffering severe pain that otherwise cannot be adequately managed without the care you are seeking. If a physician with knowledge of your medical condition determines that the care you are seeking to have paid under the plan is urgent care, then the plan must treat the claim as an urgent care claim. Otherwise, the health plan’s claims administrator will determine whether you are seeking urgent care. If you submit an urgent care claim and you later decide to receive the urgent care before a decision is made on your claim or appeal, then your claim or appeal will no longer be treated as an urgent care claim and instead will be treated as a post-service claim.

Pre-Service Claim: This is a claim you are required to submit before you receive the care or treatment you are seeking because the plan will not provide or pay for at least some of the care unless the claims administrator approves the care before it has been provided. Pre-service claims are generally service specific. Review the Health Care Benefits section of this Summary Plan Description (SPD) and your Evidence of Coverage booklet for your health plan to determine whether you need to file a pre-service claim for a specific service. You may also contact the claims administrator. If you are seeking pre-approval for urgent care, then the claim will be an urgent care claim, not a pre-service claim.

Post-Service Claim: This is a claim for care that does not need to be approved in advance of the treatment. You are asking the plan to pay for treatment that has already been provided. This is the most common type of claim.

Concurrent Care Claim: Concurrent care is an ongoing course of treatment for a specified period or a specified number of treatments (i.e. a specified number of physical therapy sessions). A concurrent care claim occurs when you wish to challenge the plan’s decision to reduce or terminate concurrent care before the end of the previously approved period or before you have received the previously-approved number of treatments. A concurrent care claim also occurs when you wish to extend concurrent care beyond the previously-approved period or number of treatments.



Deadlines for Responding to Each of the Four Types of Health Care Claims

The claims administrator must make a decision on the four types of health care claims by the following deadlines:

Urgent Care Claims

If your claim includes all information required for the claims administrator to decide whether the plan provides the benefits that you are seeking, then the claims administrator will notify you of its decision on your claim as soon as possible, taking into account the medical exigencies, but not later than 72 hours after the claims administrator receives the initial claim. If you believe that a faster response is required, please describe in your claim the medical circumstances that require an expedited response. You will receive a response even if the claims administrator fully approves your claim for urgent care.

If you do not provide enough information with your initial claim for the claims administrator to determine whether the plan provides the benefits you are seeking, then the claims administrator will notify you, within 24 hours of receipt of your claim, of the additional information that is needed. You will be provided a reasonable period of at least 48 additional hours to provide the requested information. If you provide all of the requested information by the claims administrator’s deadline, then the claims administrator will provide you with a decision on your claim within 48 hours after you provide all of the additional information. If you do not provide all of the requested information by the claim administrator’s deadline, then the claims administrator will provide you with a decision within 48 hours after the earlier of the claims administrator’s receipt of the additional information or its deadline for you to provide the additional information.

If you file a claim with the wrong person or in an incorrect manner, then, in some cases, you will be notified of that error as soon as possible and not later than 24 hours after you incorrectly filed the claim. You will be informed of the correct way to submit your claim. In some cases, you will be notified orally, but you may request a written confirmation of the correct way to file the claim. The health plan is not required to notify you of your error in filing your claim unless your claim names the person making the claim, the specific medical condition or symptom, and the specific treatment, service, or product that is being sought. Also, the claim must be received by a person who normally handles health benefit matters. For example, if you submitted your urgent care claim to your supervisor or to a third-party administrator for a retirement plan, then you may not receive a response alerting you to the proper procedure for filing your urgent care claim.



Pre-Service Claims

If your claim includes all information required for the claims administrator to approve the benefits you are seeking, then the claims administrator will notify you of its decision as to whether the plan will provide or pay for the care you are seeking within a reasonable period, in light of the medical circumstances, but not later than 15 days after the claims administrator receives the initial claim. If you believe that a faster response is required, please describe in your claim the medical circumstances that require an expedited response. You will receive a response even if the claims administrator fully approves your pre-service claim so that you know that the claim has been approved.

In some cases, the claims administrator will notify you, before the end of the normal maximum 15-day deadline for responding to your claim, that additional time is required to process your claim for reasons beyond the control of the claims administrator. The notice of the extension will inform you of the reasons for the extension and the date by which the claims administrator expects to make a decision. The claims administrator may take up to an additional 15 days to respond to your claim. If the claims administrator requests the extension because you did not submit all information that the claims administrator needs to decide on your claim, then the notice of the extension will inform you of the additional information needed by the claims administrator. You will be provided at least 45 days to provide the additional information. If you respond, by the deadline established by the claims administrator, to the request for additional information, then the claims administrator will make a decision on your claim within 15 days after your response. If you do not respond to the request for additional information by the claim administrator’s deadline, then the claims administrator will provide you with a decision within 15 days after its deadline for you to provide the additional information.

If you file a claim with the wrong person or in an incorrect manner, then, in some cases, the plan will notify you of that error as soon as possible and not later than 5 days after you incorrectly filed the claim. You will be informed of the correct way to submit your claim. In some cases, you will be notified orally, but you may request a written confirmation of the correct way to file the claim. The health plan is not required to notify you of your error in filing your claim unless your claim names the person making the claim, the specific medical condition or symptom, and the specific treatment, service, or product that is being sought. Also, the claim must be received by a person who normally handles health benefit matters. For example, if you submitted your health plan pre-service claim to your supervisor or to a third-party administrator for a retirement plan, then you may not receive a response alerting you to the proper procedure for filing your pre-service claim.



Post-Service Claims

If your claim includes all information required for the claims administrator to decide whether the plan covers the care that you received, then the claims administrator will notify you if the plan denies your claim. The notice will be provided within a reasonable period, but not later than 30 days after the claims administrator receives the initial claim.

In some cases, the claims administrator will notify you, before the end of the normal 30-day maximum deadline for responding to your claim, that additional time is required to process your claim for reasons beyond the control of the claims administrator. The notice of the extension will inform you of the reasons for the extension and the date by which the claims administrator expects to make a decision. The claims administrator may take up to an additional 15 days to respond to your claim. If the claims administrator requests the extension because you did not submit all information that the claims administrator needs to decide on your claim, then the notice of the extension will inform you of the additional information needed by the claims administrator. You will be provided at least 45 days to provide the additional information. If you respond, by the deadline established by the claims administrator, to the request for additional information, then the claims administrator will make a decision on your claim within 15 days after your response. If you do not respond to the request for additional information by the claim administrator’s deadline, then the claims administrator will provide you with a decision within 15 days after its deadline for you to provide the additional information.

Concurrent Care Claims

Special rules apply for a concurrent care claim if the claims administrator decides to restrict the concurrent care benefits that it previously approved (i.e. terminate your physical therapy before the previously-approved sessions are completed) or if you seek to extend the period of concurrent care (i.e. you seek to continue physical therapy beyond the sessions previously approved).

Reduction or Termination of Previously-Approved Concurrent Care

If the claims administrator decides to reduce or stop the treatments that it previously approved, then this decision will be treated as a denial of the previous claim to approve these benefits. (If the treatments are reduced on account of a plan amendment or the termination of the plan, then these special rules do not apply.) You will be notified of this decision before the change goes into effect. Instead of the normal deadline for appealing a



denial, you will be provided a reasonable period to appeal this decision so that you may receive a response to your appeal before the change goes into effect. Please follow the appeals procedure described in this section that applies to the denial of an urgent care claim (if the concurrent care is urgent care) or a pre-service claim (if the concurrent care is not urgent care).

Extension of Previously-Approved Concurrent Care

If you wish to extend the previously-approved period or increase the previously-approved number of treatments, then you should notify the claims administrator in writing. Your request will be treated as a claim for benefits.

If you are seeking to extend concurrent care that is urgent care, then your request will be handled as follows. If you request an increase in the period of treatment or the number of treatments at least 24 hours in advance of the expiration of the previously-approved course of treatment, then the claims administrator will notify you of its decision as to whether the plan will provide or pay for the care you are seeking as soon as possible, taking into account the medical exigencies, but not later than 24 hours after the claims administrator receives your request for an extension. If you request an increase less than 24 hours in advance of the expiration of the previously-approved course of treatment, then a decision on your request will be made in accordance with the rules that normally apply for urgent care claims. In either case, the decision will be communicated as described above for urgent care claims (i.e. the initial response may be oral).

If you are seeking to extend concurrent care that is not urgent care, then your request will be treated as a normal pre-service claim (if pre-approval is required) or post-service claim (if no pre-approval is required) and handled as described above.

If your claim for extended concurrent care is denied, then you may file an appeal of that denial and the appeal will be decided within the appropriate time frame, based on the nature of your request (i.e., an urgent care claim, a pre-service claim, or a post-service claim).

How to Appeal if Your Claim for Health Benefits Is Denied

If your claim for health benefits is denied, then you may appeal that denial. When you appeal, please follow the specific procedures outlined for your plan later in this section. Except in the case of an urgent care claim, you must submit your appeal in writing. If your appeal is seeking urgent care, then you may make your appeal orally and submit necessary information by telephone, fax, email, or some other expedited method. The claims administrator may provide an oral response to your appeal of a claim involving urgent care.

You must submit your appeal to the claims administrator within 180 days after your claim has been denied.



Deadlines for Responding to Your Appeal for Each of the Four Types of Health Care Claims

The claims administrator must make a decision on your appeal of a denial of one of the four types of health care claims by the following deadlines.

Urgent Care Claims

The claims administrator will notify you of its decision as to whether the plan will provide or pay for the care you are seeking as soon as possible, taking into account the medical exigencies, but not later than 72 hours after the claims administrator receives the appeal. If you believe that a faster response is required, please describe in your claim the medical circumstances that require an expedited response.

Pre-Service Claims

If the health plan provides only one regular appeal, then the claims administrator will notify you of its decision as to whether the plan will provide or pay for the care you are seeking within a reasonable period, in light of the medical circumstances, but not later than 30 days after the claims administrator receives the appeal. If the health plan provides for two appeals, you will be notified, with respect to any one of such two appeals, not later than 15 days after the claims administrator receives the appeal.

If you believe that a faster response is required for any appeal, please describe in your appeal the medical circumstances that require an expedited response.

Post-Service Claims

If the health plan provides only one regular appeal, then the claims administrator will notify you if the plan will not pay for some or all of the care you received. The notice will be provided within a reasonable period, but not later than 60 days after the claims administrator receives the appeal. If the health plan provides for two appeals, you will be notified, with respect to any one of such two appeals, not later than 30 days after the claims administrator receives the appeal.

Concurrent-Care Claims

As noted above, if the claims administrator decides to reduce or stop previously-approved treatments, then its decision will be treated as a denial of your original claim and you may file an appeal of that denial. As noted in the discussion of concurrent care claims, sometimes there may be faster deadlines for filing and responding to the claims administrator’s decision to reduce or stop your previously-approved treatments.



If your claim seeking to extend previously-approved concurrent care is denied, then you may file an appeal of that denial and the appeal will be decided within the appropriate time frame, based on the nature of your request (i.e. an urgent care claim, a pre-service claim, or a post-service claim).

MEDICAL PLANS CLAIMS AND APPEALS

Kaiser Foundation Health Plan

If you wish to submit a claim for benefits under your Kaiser Foundation Health Plan (KFHP) policy, contact Member Services.

Emergency Claims

Depending on where you receive emergency care, you may be responsible for paying for emergency services at a facility not affiliated with Kaiser Permanente and submitting your claim to Kaiser Permanente Claims and Referrals. Once you submit a claim, KFHP will reimburse you — if the emergency treatment would normally have been covered by KFHP and if delaying treatment would have resulted in death, serious disability, or jeopardy to your health. KFHP will pay reasonable charges, excluding your emergency copayment, any other copayments that would have applied at Kaiser Permanente, or any amounts payable under insurance and government programs other than Medicaid. Claims must be submitted within 12 months of treatment.

Where to File Your KFHP (including Emergency) Claims

Submit your completed claim forms to:

Kaiser Foundation Health Plan, Inc. Claims DepartmentP.O. Box 7004Downey, CA 90242-70041-800-464-4000

Medicare members are subject to a slightly different provision. Please refer to the Evidence of Coverage booklet for your health plan.

Appeals

This appeal procedure applies to claims for out-of-plan emergency or urgent care services, and to in-plan pre-service, post-service, and urgent care situations in which KFHP has denied a claim to provide or pay for a service covered by KFHP to which you believe you are entitled. Please refer to the Evidence of Coverage for your plan for details on the applicable time frames and procedures to file your appeals.



KFHP appeals should be sent to:

Kaiser Foundation Health Plan, Inc. Claims Administration DepartmentP.O. Box 23280Oakland, CA 946231-800-464-4000

Medicare members are subject to a slightly different provision. Refer to the Evidence of Coverage booklet for your health plan.

Arbitration Agreement

If you are a KFHP member, any dispute between you, your heirs, relatives, personal representatives, or other associated parties on the one hand and KFHP, its contracted health care providers, their agents, employees, or other associated parties on the other hand, arising out of or relating to KFHP membership, including any claim for medical or hospital malpractice (a claim that medical services or items were unnecessary or unauthorized or were improperly, negligently, or incompetently rendered), for premises liability, or relating to the coverage for, or the delivery of, services or items, irrespective of the legal theories upon which the claim is asserted, must be decided by binding arbitration under California law and not by lawsuit or resort to court process, except as applicable law provides for judicial review of arbitration proceedings. You agree to give up your and their right to a court or jury trial and accept the use of binding arbitration. The following types of claims are not subject to binding arbitration: Small Claims Court cases, claims subject to a Medicare appeals procedure as applicable to Kaiser Permanente Senior Advantage members, and claims that cannot be subject to binding arbitration under governing law. The full arbitration provision is contained in the Evidence of Coverage. You can obtain a copy of the Evidence of Coverage brochure by calling Member Services at 1-800-464-4000 or by visiting kp.org under the My Health Manager tab, click My Coverage and costs, then click My Documents in the left hand navigation.

Member Satisfaction Grievance Process

The California Department of Managed Health Care is responsible for regulating health care service plans. The Department has a toll-free telephone number, 1-800-400-0815, to receive complaints regarding health plans. The hearing and speech impaired may use the California Relay Service’s toll-free telephone numbers 1-800-735-2929 (TTY) or 1-888-877-5378 (TTY) to contact the department. You can access and download complaint forms and instructions online at dmhc.ca.gov. If you have a grievance against a health plan, you should contact the plan and use the plan’s grievance process. If you need the Department’s help with a complaint involving an emergency grievance or with a grievance that has not been satisfactorily resolved by the plan, please call 1-800-400-0815.



ADDITIONAL INFORMATION FOR CERTAIN OTHER MEDICAL CLAIMS AND APPEALS

(Related Supplemental Medical Plan, Alternate Mental Health Plan and Comprehensive Plan)

Claims

Claim forms are generally available online at Meritain Health. Contact Meritain Health if you have difficulty locating the appropriate claim form. A separate claim form should be completed for each patient. Carefully follow the instructions for completing the claim forms. If you have questions, contact Meritain Health for assistance.

When submitting your claim form, attach your itemized bills for services received. Properly itemized bills are required as evidence to support your claim for payment of covered services. If you have prescription drug charges, submit itemized receipts which include the patient’s name, prescription number, type, dosage, quantity, and cost. The actual bills are required; copies and handwritten bills are not acceptable. Some claims will need a valid Kaiser Permanente Authorized Evidence of Exclusion or similar document (which may be referred to as a denial of service letter) in order to be processed.

In addition, you will be required to provide coordination of benefits information in some cases. Contact Meritain Health if you need additional information. Failure to provide coordination of benefits information may delay the processing of your claim or cause your claim to be denied.

If you would like Meritain Health to pay the physician or health care provider directly, contact Meritain Health directly to determine if this option is available to you.

You must submit your completed claim form and supporting documentation within 12 months from the date services were received. In many cases, your claim will be processed within one month from the date Meritain Health receives it, if no additional information is necessary. Missing, incomplete, or unclear information may cause your claim to be denied.

Mail or email your claims directly to Meritain Health at the following address:

Meritain HealthP.O. Box 853921Richardson, TX 75085-3921716-541-6690Email: [email protected]



In the case of an urgent care claim, a request for an expedited review may be submitted orally by calling Meritain Health at 1-800-925-2272. All necessary information, including the claim determination, may be transmitted between the plan and the covered person (or authorized representative) via telephone, facsimile, or other available similarly expeditious methods.

Continuing Claims

One original claim form per injury or illness is required each calendar year. Therefore, if you received services during a calendar year for an injury or illness where the diagnosis and health care provider remains the same, you or your provider do not need to submit a new claim form each time. You may submit the original itemized bill with your Social Security or Meritain Health member number written on it or include a copy of the original claim form.

Appeals

Your appeal rights are repeated at the bottom of every Meritain Health Explanation of Benefits. In the case of an urgent care claim appeal, a request for an expedited review may be submitted orally by calling Meritain Health at 1-800-925-2272. All necessary information, including the appeal determination, may be transmitted between the plan and the covered person (or authorized representative) via telephone, facsimile, or other available similarly expeditious methods.

Appeals of non-urgent care claims should be sent to:

Appeals DepartmentMeritain HealthP.O. Box 41980Plymouth, MN 55441

For further appeals processes, contact PHR Shared Services at 1-877-608-0044.

DENTAL PLANS CLAIMS AND APPEALS

Delta Dental or United Concordia

If you receive services from a dentist in the Delta Dental or United Concordia network, you do not need to file any claims — your Delta Dental or United Concordia dentist will file the claims for you. If you have questions about the services you receive from a Delta Dental or United Concordia dentist, you may discuss the matter with your dentist, or if you continue to have concerns, you may contact Delta Dental or United Concordia through the applicable contact listed below:

Delta Dental of CaliforniaP.O. Box 997330 Sacramento, CA 95899-7330 Phone: 1-800-765-6003 deltadentalins.com

United ConcordiaPO Box 10194Van Nuys, CA 91410Phone: 1-800-937-6432unitedconcordia.com



If Your Claim is Denied

If your claim for benefits is fully or partially denied, you are entitled to a review of that decision by Delta Dental or United Concordia, as applicable. Your written request should be sent to the applicable above address and must be submitted within 180 days after you receive notice of claim denial. The request should include the reason you believe the claim was improperly denied and any appropriate data, including a copy of the treatment form, Notice of Payment and any other relevant information.

Upon request and free of charge, Delta Dental or United Concordia, as applicable, will provide you with copies of any pertinent documents that are relevant to the claim, a copy of any internal rule, guideline, protocol, and/or explanation of the scientific or clinical judgment if relied upon in denying or modifying the claim.

For more information, call Delta Dental or United Concordia. Additionally, please refer to the Evidence of Coverage booklet for your dental plan.

EMPLOYEE ASSISTANCE PROGRAM (EAP) CLAIMS AND APPEALS

Kaiser Foundation Health Plan (KFHP) or Physician Work-Life Solutions

If you receive employee assistance program services from KFHP or Physician Work-Life Solutions, you do not need to file any claims. If you have questions about the services you receive from a KFHP or Physician Work-Life Solutions, you may discuss the matter with your provider, or if you continue to have concerns, you may contact PHR Shared Services.

HEALTH CARE FLEXIBLE SPENDING ACCOUNT CLAIMS AND APPEALS

Filing a Claim

You may obtain a Health Care Flexible Spending Account reimbursement claim form from WageWorks. You may contact their customer service center at 1-877-924-3967 or obtain claim forms from their website at wageworks.com. Here is how the reimbursement process works:

• You pay for eligible health care expenses, either out-of-pocket or by using your WageWorks Healthcare Debit Card, as they are incurred. To request reimbursement of expenses paid out-of-pocket, you complete, sign, and submit a claim form — along with your original or photocopied receipt(s) with a description of the expense; a receipt with a prescription number or the WageWorks Letter of Medical Necessity; and/or Explanation of Benefits (EOB), as necessary — to WageWorks. Also



include the date of service, amount paid for the service, provider name, and type of service with your claim. You may also be asked to provide WageWorks with this documentation to verify that items or services purchased with your WageWorks Healthcare Debit Card were eligible expenses.

• You must file your claim for expenses incurred during the plan year by March 31 of the following year.

• You may file your claim with the WageWorks EZ Receipts mobile application at wageworks.com. For the fastest reimbursement, submit it online at wageworks.com. You may also fax it to 1-877-353-9236 or mail it to the following address:

WageWorks Claims Administrator P.O. Box 14053 Lexington, KY 40512

• You may receive your reimbursement either by check or direct deposit.

• You may check on the status of your claim or payment online at wageworks.com.

According to IRS rules, an expense is considered incurred when service is actually received, not when you are billed or when you pay for the service.

Appeals for Health Care Flexible Spending Account Claims

If your claim for benefits under the Health Care Flexible Spending Account is denied, you have the right to appeal the decision. You must make the appeal request within 180 days after the date of the claim denial notice. Send the written request to the claims administrator for the plan as follows:

Health Care Flexible Spending Account:

WageWorks Claims Appeal BoardP.O. Box 991Mequon, WI 53092-0993

You can also send the appeal by fax to 1-877-220-3248.

The request must explain why you believe a review is in order, and it must include supporting facts and any other pertinent information. The claims administrator may require you to submit such additional facts, documents, or other material as it may deem necessary or appropriate in making its review.



DISABILITY PLANS CLAIMS AND APPEALS

There are special rules that apply to claims and appeals under the disability plans. Your claim might be made in different circumstances. For example, you might be applying for long-term disability benefits. If the claims administrator decides to discontinue payment of your long-term disability benefits before they were scheduled to end (i.e. because the claims administrator believes that you are no longer disabled), then that decision will be treated as a denial of your claim for long-term disability benefits and you may appeal that denial in accordance with the rules noted below. If you seek to extend payment of your disability benefits, then that request will be treated as a claim for benefits and the claims administrator will respond to your claim as noted below.

The disability claims and appeals rules also apply to claims and appeals for benefits under other types of plans where the claims administrator for that other type of plan must determine that you are disabled in order to approve your claim. For example, if different rules apply for the amount of or the payment commencement date of benefits under a retirement plan when you are disabled and the issue in your claim and appeal is whether or not you are disabled, then these rules apply with respect to that part of your retirement plan claim and appeal.

Similarly, if an insurance plan includes a waiver of your payment of premiums while you are disabled, then these rules apply with respect to a claim or appeal relating to the premium waiver. However, if the claims administrator under the other plan does not need to determine whether you are disabled, but instead only needs to find out whether someone else has determined that you are disabled, then these special rules do not apply. For example, if the claims administrator of a retirement plan only needs to determine whether the Social Security administration or the claims administrator for the long-term disability plan has determined whether you are disabled, then these special rules do not apply if your claim or appeal is based on whether you are entitled to the benefit under the retirement plan.

Claims

Life Insurance Company of North America (LINA) is the insurer and third-party administrator for the

• Short Term Disability (STD) plans

• Long-Term Disability (LTD) plans

Provident Life and Accident Insurance Company (Provident) is the insurer and third-party administrator for the Supplemental Individual Disability Insurance.

You may complete a claim form with LINA by calling the toll-free number, 1-800-732-1603, to initiate your claim. You may either complete a claim form with Provident by calling Provident’s toll-free number, 1-877-225-2712,



to initiate your claim. After you initiate your claim, your LINA or Provident claims representative will help you through the steps and supporting documentation required to complete your claim.

Deadlines for Responding to Your Claims for Disability Benefits

The claims administrator will make a decision on your claim within a reasonable period but not later than 45 days after it receives your claim form. In some cases, the claims administrator will notify you, before the end of the normal 45-day maximum period for responding to your claim, that additional time is required to process your claim for reasons beyond the control of the claims administrator. Any notice of the extension will inform you of the reasons for the extension and the date by which the claims administrator expects to make a decision. The claims administrator may take up to an additional 30 days to respond to your claim. The claims administrator may again notify you, before the end of the initial 30-day extension, that additional time is required to process your claim for reasons beyond the control of the claims administrator. In that event, the claims administrator may take up to another 30 days to respond to your claim. When the claims administrator requests either the first or second 30-day extension, it will tell you the standards that must be satisfied to approve your benefit claim, the unresolved issues that require a delay in the decision on your claim, and the additional information needed to resolve those issues. You will be provided at least 45 days to provide the requested information. If the claims administrator needs additional information from you, then the time between the date you are requested to send the additional information and the date the information is received will not count towards the required deadlines.

Appeals

If your claim is denied, LINA or Provident, as applicable, will provide you with a written response and you will have the right to file an appeal in writing. Your written appeal must be received by the claims administrator at the following address within 180 days after your claim was denied:

Life Insurance Company of North America1601 Chestnut StreetPhiladelphia, PA 19192

Provident Life and Casualty Insurance Company1 Fountain SquareChattanooga, TN 374402



Deadlines for Responding to Your Appeal for Disability Benefits

If the claims administrator denies your appeal, then the claims administrator will provide a written response within a reasonable period but not later than 45 days after it receives your appeal. In some cases, the claims administrator will notify you, before the end of the normal 45-day maximum deadline for responding to your appeal, that additional time is required to process your appeal for reasons beyond the control of the claims administrator. In that event, the claims administrator may take up to an additional 45 days to respond to your appeal. When the claims administrator requests a 45-day extension, it will inform you of the special circumstances requiring the extension and the date on which it expects to make a decision on your appeal. If the claims administrator needs additional information from you to resolve your appeal, then the time between when you are requested to send the additional information and the time when you furnish that information will not count towards the additional 45 days that the claim administrator has to decide your appeal. Before issuing a denial of your appeal based on a new or additional rationale, the claims administrator will provide you with the rationale, free of charge and sufficiently in advance of the date the appeal must be decided to give you a reasonable opportunity to respond prior to that date.

Refer to the Group Insurance Certificate for your disability plan for more information.

What to Do About a Denial After Final Review

If your appeal is denied and you disagree with the final decision, you may file a lawsuit under ERISA section 502(a). If a contractual limitations period applies to your disability claim, the notice of denial will describe that limitations period and will include the calendar date on which the contractual limitations period expires for the claim. If you wish, you may take the matter up with the California Department of Insurance. You may contact them at the address below:

California Department of Insurance Claims Service Bureau300 S. Spring St., 11th Floor Los Angeles, CA 90013 1-213-346-6570

Retiree Benefits Claims and Appeals

Unless otherwise noted, retiree medical claims must be filed within 12 months of the date of service or when the expense was incurred.



Retiree Health and Welfare Eligibility Claims

To dispute your eligibility for retiree health and welfare benefits, write PHR Shared Services. You will need to submit a written inquiry to the address listed below within 6 months of the event that gives rise to the question:

Southern California Permanente Medical GroupPHR Shared Services393 E. Walnut Street Pasadena, CA 91188-0001

PHR Shared Services will review your written inquiry and provide you with a response no later than 90 days after PHR Shared Services receives your inquiry.

Retiree Health and Welfare Benefits Eligibility Appeals

If you do not agree with the PHR Shared Services determination, you may appeal the response by submitting a written request for review to the SCPMG Welfare Benefits Committee (Committee) within 90 days of the date on the response to your written inquiry. Your request for review will need to be in writing and state all the facts in support of the appeal. You may submit written comments, documents, records or other information relating to your appeal. The written request for review will need to be sent to the following address:

Southern California Permanente Medical GroupSCPMG Welfare Benefits Committee c/o PHR Shared Services393 E. Walnut Street Pasadena, CA 91188-0001

Upon request and free of charge, you will be provided with reasonable access to, and copies of all documents, records, and other information relevant to your dependent eligibility appeal.

If you choose to appeal the decision, the Committee will act on your request for review at the regularly scheduled meeting of the Committee that immediately follows receipt of such request, unless the request is filed within the 30 days preceding the date of the meeting. In that case, the Committee will act on the request no later than the date of the second regularly scheduled meeting of the Committee following the request for review. In all circumstances, if there are special circumstances that require additional time, the Committee will provide written notice of the extension prior to the commencement of the extension, describing the special circumstances and the date by which the decision will be made. In all cases, the Committee will act no later than the third regularly scheduled meeting following the plan’s receipt of such request.

After its review, the Committee will either reverse the earlier decision or it will deny the appeal. If the appeal is denied, written notice of the denial will be provided to you within five days of the Committee’s decision.



The written denial upon review will contain specific reasons for the plan’s decision and specific references to the relevant plan provisions upon which the decision is based.

If the final decision (after the required levels of appeal) is adverse to you, you (or your representative) may then file an action for benefits in federal court under Section 502(a) of ERISA. Any legal action regarding denied retiree health and welfare eligibility inquiries or claims must be filed within one year of the event that gave rise to the inquiry or claim.

Please note: you are required to first comply with this appeals procedure before pursuing your claim in any judicial or administrative proceeding. If you do not pursue and exhaust your rights under this procedure in a timely manner, the Committee’s decision will become final and binding.

RETIREE MEDICAL CLAIMS AND APPEALS

Claims

If you wish to submit a claim for benefits under the Kaiser Permanente Senior Advantage plan, contact Member Services or refer to the Evidence of Coverage booklet for your plan.

Appeals

For appeals of denied medical benefit claims, you may write to the address shown in the denial notice. Please refer to the Evidence of Coverage booklet for your plan.

MEDICARE PART B REIMBURSEMENT

Filing a Claim: Medicare Part B

You can submit your claims for Medicare Part B reimbursement by mail as follows:

Mail your claim form and documentation to:

Southern California Permanente Medical Groupc/o PHR Shared Services393 E. Walnut Street Pasadena, CA 91188-0001

PHR Shared Services will review your claim and provide you with a determination no later than 30 days after they receive your claim. The written claim decision, if a denial, will contain specific reasons for the plan’s decision and specific references to the relevant plan provisions upon which the decision is based.



Appeals for Denied Retiree Medicare Part B Claims

If your claim for Medicare Part B reimbursement is denied, you have the right to appeal the decision. You must make a written appeal request within 180 days after the date of the claim denial notice. Send the written request to the SCPMG Welfare Benefits Committee (Committee) at the following address:

Southern California Permanente Medical GroupSCPMG Welfare Benefits Committee c/o PHR Shared Services393 E. Walnut Street Pasadena, CA 91188-0001

The request must explain why you believe a review is in order, and it must include supporting facts and any other pertinent information. The Committee may require you to submit such additional facts, documents, or other material as it may deem necessary or appropriate in making its review.

Upon request and free of charge, you will be provided with reasonable access to, and copies of all documents, records and other information relevant to your claim.

If you choose to appeal the claim determination, the Committee will issue a written decision upon review within 60 days after it receives your request for review. The review by the Committee will not afford deference to the initial claim denial, but will assess the information you provide as if the Committee was looking at the claim for the first time. The written decision upon review will contain specific reasons for the plan’s decision and specific references to the relevant plan provisions upon which the decision is based.

If the final decision (after the required levels of appeal) is adverse to you, you (or your representative) may then file an action for benefits in federal court under Section 502(a) of ERISA. Any legal action regarding denied claims must be filed within one year of the event that gave rise to the claim.

Please note: You are required to first comply with this appeals procedure before pursuing your claim in any judicial or administrative proceeding. If you do not pursue and exhaust your rights under this procedure in a timely manner, this decision will become final and binding.



RETIREMENT PLAN BENEFITS CLAIMS AND APPEALS

Defined Contribution Plan Claims for the Keogh and 401(k) Plans

For information about claims and appeals under the Keogh Plan or 401(k) Plan, refer to the Retirement and Savings Plans section of this Handbook.

GENERAL INFORMATION ABOUT OTHER TYPES OF CLAIMS AND APPEALS

The following rules relate to claims and appeals that are not made under health plans, retirement plans, eligibility for retiree medical, or Medicare Part B premium reimbursements, and that are not subject to the special rules for disability benefits.

Life Insurance Company of North America (LINA) is the insurer for the life insurance and accidental death dismemberment plans; NYLife or Genworth, as applicable, is the insurer for long-term care insurance; and MetLife is the insurer and third-party administrator for the business travel accident insurance. LINA, NYLife, Genworth, and MetLife are referred to in this section as the Insurance Company.

Life Insurance, Retiree Life Insurance, Accidental Death and Dismemberment, Business Travel Accident, and Long-Term Care Claims

Contact the applicable Insurance Company to initiate a claim. The Insurance Company will provide the claimant with a claim packet with instructions on how to complete the claim process. You must follow the claim process carefully. Failure to do so could result in a denied claim.

A copy of the death certificate is required to process a claim for death benefits. Send completed claims to the address below:

For life insurance claims, please contact Life Insurance Company of North America at:

Life Insurance Company of North America1601 Chestnut StreetPhiladelphia, PA 19192Phone: 1-800-552-5744

For business travel accident claims, please contact MetLife at:

MetLife - Group Life ClaimsP.O. Box 6100 Scranton, PA 18505 Phone: 1-800-638-6420



For long-term care claims for policies purchased before November 2012, please contact New York Life Insurance Company at:

New York Life Insurance CompanyLong-Term Care Division98 San Jacinto Blvd, Suite 800Austin, TX 78701Phone: 1-888-414-0821

For long-term care claims for policies purchased on or after March 2014, please contact Genworth Insurance Company at:

Genworth Insurance CompanyGroup Processing Center - SCPMGP.O. Box 64010St. Paul, MN 55164-0010Phone: 1-800-416-3624


The applicable Insurance Company will make a decision on your claim within a reasonable period but not later than 90 days after it receives your claim form. In some cases, the applicable Insurance Company will notify you, before the end of the normal 90-day maximum period for responding to your claim, that additional time is required to process your claim on account of special circumstances. In that event, the applicable Insurance Company may take up to an additional 90 days to respond to your claim. When the applicable Insurance Company requests the 90-day extension, it will indicate the special circumstances and the date by which it expects to make a decision on your claim.

How to Appeal a Denial of Your Initial Claim

If your claim is denied, the applicable Insurance Company will provide you with a written explanation of the denial and you will have the right to request a review of your claim by writing to the applicable Insurance Company. Please include in your appeal letter the reason(s) you believe the claim was improperly denied, and submit any additional comments, documents, records or other information relating to your claim that you deem appropriate to enable the applicable Insurance Company to give your appeal proper consideration. Upon your written request, the applicable Insurance Company will provide you with a copy of the records and/or reports that are relevant to your claim. Your appeal can be sent to the following address within 60 days of the claim denial:

For life insurance claims, please contact Life Insurance Company of North America at:

Life Insurance Company of North America1601 Chestnut StreetPhiladelphia, PA 19192Phone: 1-800-552-5744



For business travel accident claims, please contact MetLife at:

MetLife - Group Life ClaimsP.O. Box 6100 Scranton, PA 18505 Phone: 1-800-638-6420

For long-term care claims for policies purchased before November 2012, please contact New York Life Insurance Company at:

New York Life Insurance CompanyLong-Term Care Division98 San Jacinto Blvd, Suite 800Austin, TX 78701Phone: 1-888-414-0821

For long-term care claims for policies purchased on or after March 2014, please contact Genworth Insurance Company at:

Genworth Insurance CompanyGroup Processing Center - SCPMGP.O. Box 64010St. Paul, MN 55164-0010Phone: 1-800-416-3624


If the applicable Insurance Company denies your appeal, the applicable Insurance Company must notify you of its decision on your appeal within a reasonable period but not later than 60 days after it receives your appeal. In some cases, the applicable Insurance Company will notify you, before the end of the normal 60-day maximum deadline for responding to your appeal, that additional time is required to process your appeal on account of special circumstances. In that event, the applicable Insurance Company may take up to an additional 60 days to respond to your appeal. When the applicable Insurance Company requests the 60-day extension, it will indicate the special circumstances and the date by which it expects to make a decision on your claim. If the applicable Insurance Company needs additional information from you to resolve your appeal, then the time between when you are requested to send the additional information and the time when you furnish that information will not count towards the additional 60 days that the applicable Insurance Company has to decide your appeal.



Refer to the Group Insurance Certificate for the insurance plan for more information.

What to Do About a Denial After Final Review

If your appeal is denied and you disagree with the final decision, you may file a lawsuit under ERISA 502(a) within one year of the date of your appeal determination (unless a longer period is provided under the insurance policy). If you wish, you may take the matter up with the California Department of Insurance. You may contact them at the address below:

California Department of Insurance Claims Service Bureau300 S. Spring St., 11th Floor Los Angeles, CA 90013 Phone: 213-346-6570

ADMINISTRATION OF THE PLANS

Entity Plan Sponsor Plan Administrator



Walnut Center 393 E. Walnut St.Pasadena, CA 91188EIN # 95-1750445

For the following Health and Welfare Programs:

• Dental programs

• Kaiser Permanente employee assistance program

• Health care spending accounts

• Business Travel Accident

Kaiser Foundation Health Plan, Inc.c/o Kaiser Permanente Administrative Committee (KPAC)One Kaiser Plaza Oakland, CA 94612

For all other Health and Welfare Programs: Southern California Permanente Medical GroupSCPMG Welfare Benefits Committee393 E. Walnut St.Pasadena, CA 91188

For the Retirement Plans (Keogh and the 401(k) Plan): Southern California Permanente Medical GroupSCPMG Retirement Committee393 E. Walnut St.Pasadena, CA 91188





Southern California Permanente Medical GroupAttn: Medical Director of Business ManagementWalnut Center 393 E. Walnut St.Pasadena, CA 91188


The plan administrator and named fiduciary for purposes of ERISA administers each benefit plan described unless otherwise noted in this Handbook.

The plan administrator has the authority to administer each of its benefit plans and may delegate this authority in writing to third parties such as insurers or a committee. The plan administrator also may delegate its authority to approve or deny claims for benefits to a claims administrator. The plan administrator or, to the extent delegated to a third party, its delegate has the exclusive and full discretionary authority to control and manage the administration and operation of each benefit plan described in your SPD, including but not limited to the following:

• The discretionary authority to make and enforce rules for the administration of each benefit plan, including the designation of forms to be used in such administration

• The discretionary authority to construe and interpret each and every document setting forth the applicable terms of a plan, including official plan documents, SPDs, and insurance contracts

• The discretionary authority to decide questions regarding the eligibility of any person to participate in any benefit plan

• The discretionary authority to approve or deny claims for benefits under each benefit plan unless discretionary authority has been delegated in writing to a third party, such as an insurer, claims administrator or administrative committee

• The discretionary authority to appoint or employ agents, including but not limited to, counsel, accountants, consultants, and other persons to assist in the administration of each benefit plan

Welfare and Retirement Plans

The following are the plan names, identification numbers, and other relevant information on the welfare and retirement plans available to you. You may or may not be eligible to participate in all of these plans. For all plans, the plan year ends December 31.



Plan Name/Plan Options

Plan Sponsor EIN #

ID No. Type of Plan Claims Administrator


Plan Trustee

Funding Medium

Contributing Source

Health and Welfare Programs

The Southern California Permanente Medical Group (SCPMG) Health and Welfare Plan

95-1750445

560 Health and Welfare Programs

Kaiser Foundation Health Plan

Insured Kaiser Foundation Health Plan, Inc. One Kaiser Plaza Oakland, CA 94612

Insured N/A Insured agreement premiums paid from general assets

SCPMG and physician

Kaiser Permanente Supplemental Medical Plan

Self-Funded Appeals Department, Meritain Health

P.O. Box 41980Plymouth, MN 55441

Express Scripts Prescription Drug plan:

Mail PharmacyBox 66773St Louis, MO 63166-6773

Self-Funded N/A Paid from general assets

SCPMG and physician

Alternate Mental Health

Self-Funded Appeals & Reconsideration Unit Meritain Health P.O. Box 27267Minneapolis, MN 55427-0267


SCPMG and physician



Comprehensive Medical

Self-Funded Appeals Department, Meritain Health P.O. Box 41980Plymouth, MN 55441

Express Scripts Prescription Drug plan: Mail PharmacyBox 66773St Louis, MO 63166-6773


SCPMG and physician

Employee Assistance Program - KFHP

Self-Funded Kaiser Foundation Health Plan, Inc. One Kaiser Plaza Oakland, CA 94612


SCPMG

Employee Assistance Program – Physicians Work Life Solutions

Self-Funded Physicians Work Life Solutions (800) 505-1879

TDD: (800) 697-0353


SCPMG

Dental Preferred Provider Organization

Self-Funded Delta Dental of California 100 First Street San Francisco, CA 94105


SCPMG and physician

Dental HMOInsurance

Insured DeltaCare USA 12898 Towne Center Drive Cerritos, CA 90703


SCPMG and physician

Dental Insurance

Insured United Concordia 4401 Deer Path Road Harrisburg, PA 17110


SCPMG and physician




Insured Life Insurance Company of North America 1601 Chestnut Street Philadelphia, PA 19192


SCPMG

Optional Life Insured Life Insurance Company of North America 1601 Chestnut Street Philadelphia, PA 19192


Physician

Disabled Physicians’ Life Insurance



SCPMG

Spouse/Domestic Partner LifeInsurance



Physician

Retiree Life and Tapered Life



SCPMG

Short-Term Disability Insurance



SCPMG

Long-Term Disability Insurance

Insured Life Insurance Company of North America

1601 Chestnut Street

Philadelphia, PA 19192


Physician



Supplemental Individual Long-Term Disability Insurance

Insured Provident Life and Accident Insurance Company 1 Fountain Square Chattanooga, TN 37402


Physician


Insured MetLife Group Life Claims P.O. Box 6100 Scranton, PA 18505


SCPMG

Health Care Flexible Spending Account

Spending Account

WageWorks P.O. Box 14053 Lexington, KY 40512

Third-Party N/A N/A Physician

Long-Term Care Insurance (for policies purchased before November 2012)

Insured NYLife Life Insurance Company Long-Term Care Division 98 San Jacinto Blvd Austin, TX 78701

Insured N/A N/A Physician

Long-Term Care Insurance (for policies purchased on or after March 2014)

Insured Genworth Life Insurance Company

Group Processing Center – SCPMG P.O. Box 64610 St. Paul, MN 55164-0010

Insured N/A N/A Physician

Retirement Plans

95-1750445

N/A



SCPMG Physicians’401(k) Plan

95-1750445


Schwab Retirement Plan Services, Inc.

c/o Participant Services- SCPMG

P.O. Box 81675

Austin, TX 78708

Third-Party Administrator/

Recordkeeper

Charles Schwab

211 Main Street, 14th Floor

San Francisco, CA 94105

Trust Physician

SCPMG Keogh Plan

95-1750445


Schwab Retirement Plan Services, Inc.

c/o Participant Services- SCPMG

P.O. Box 81675

Austin, TX 78708

Third-Party Administrator/

Recordkeeper

Charles Schwab

211 Main Street, 14th Floor

San Francisco, CA 94105

Trust Physician


Your SCPMG retirement plans and the Internal Revenue Code (IRC) require that there be a bona fide separation from service before there can be a distribution of retirement benefits or before your Keogh Plan contributions can stop. This means that there can be no intent at the time of your separation (when you leave and retire from SCPMG) on either your part or that of your supervisor or other SCPMG personnel to re-employ you after you have taken a distribution of benefits or stopped your Keogh Plan contributions. This bona fide separation from service requirement means you may not leave with the intent to return as a physician, an employee or in such other capacities as consultant or contractor. This does not mean you may never return to SCPMG. You may return at some time in the future if you are applying for a bona fide open position. However, if you return, it must be because of changed circumstances after you terminate and retire, and not because of an agreement made prior to termination and retirement.

Third Party Responsibility

The SCPMG Health and Welfare Plan has first rights of subrogation and reimbursement. As a condition of receiving plan benefits, eligible physicians and their covered dependents (each a “covered individual”) grant specific and first rights of subrogation, reimbursement, and restitution to the SCPMG Health and Welfare Plan with respect to benefits they receive from the SCPMG Health and Welfare Plan that either relate to an injury, illness or condition which results from the act or omission of a third party or are, otherwise, subject to any reimbursement provision of a no fault automobile



insurance policy. Such rights shall come first and shall not be adversely impacted in any way by:

• The “make whole doctrine” (i.e. the covered individual’s recovery of his/her full damages or attorney’s fees), contributory or comparative negligence, the common fund doctrine, or any other defense or doctrine which may limit the SCPMG Health and Welfare Plan’s rights (equitable or otherwise); or

• The manner in which any recovery by a covered individual is characterized or structured (i.e. as lost wages, damages, attorney’s fees, rather than as for medical expenses)

The SCPMG Health and Welfare Plan’s rights of subrogation, reimbursement, and restitution shall extend to any property (including money), without regard to the type of property or the source of the recovery, including any recovery from the payment or compromise of a claim (including an insurance claim), a judgment or settlement of a lawsuit, resolution through any alternative dispute resolution process (including arbitration), or any insurance (including insurance on the covered individual, no-fault coverage, uninsured and/or underinsured motorist coverage).

The SCPMG Health and Welfare Plan is entitled to an equitable lien by contract and creation of a constructive trust. At the time the SCPMG Health and Welfare Plan pays benefits which may be subject to the plan’s right of reimbursement, subrogation, or restitution, the eligible physician and/or covered dependent shall at that time grant to the SCPMG Health and Welfare Plan (as a condition of such payment) an equitable lien by contract in any property described above, without regard to the identity of the property’s source or holder at any particular time; or whether property at the time the property exists, is segregated, or whether the covered individual has any rights to it. Until the time such equitable lien by contract is completely satisfied, the covered individual or other holder of the property that is subject to such equitable lien by contract (i.e. an account or trust established for the benefit of the covered individual, an insurer, etc.) shall hold such property as the SCPMG Health and Welfare Plan’s constructive trustee. Such constructive trustee shall immediately deliver such property to the SCPMG Health and Welfare Plan upon the direction of the SCPMG Health and Welfare Plan to satisfy the equitable lien by contract.

Obligations of the Eligible Physician and/or Covered Dependent

The covered individual shall:

• Not assign any rights or causes of action he or she may have against others (including under insurance policies) which may implicate the plan’s right to reimbursement, subrogation, or restitution without the express written consent of the plan;

• Cooperate with any plan’s and take any action that may be necessary to protect the plan’s interests as described in this SPD.



• Immediately take or regain possession of any property subject to the plan’s equitable lien by contract in his or her own name, place it in a segregated account within his or her control at least in the amount of the equitable lien, and not alienate it or otherwise take any action so that such property is not in his or her possession prior to the satisfaction of such equitable lien by contract; and

• Promptly notify the plan of the possibility that the circumstances regarding the payment of benefits by the plan may be subject to the plan’s right of reimbursement, subrogation, or restitution, or of the submission of any claim or demand letter, the filing of any legal action or request for any alternative dispute resolution process, or of the commencement of any trial or alternative dispute resolution process (at least 30 days prior notice), or of any agreement (relating to any claim, legal action or alternative dispute resolution), that relates to any property that may be subject to the plan’s rights of subrogation, reimbursement, restitution, equitable lien by contract, or as beneficiary of a constructive trust.

Should the covered individual himself/herself directly receive any recovery, upon his/her receipt of any such recovery, the covered individual shall provide the plan administrator with written notice of the receipt of such recovery, including the amount and source(s) of the recovery, and shall not distribute any or all of such recovery to any person or entity other than the plan until at least 60 days have passed after the date of the notice to the plan administrator. Should the covered individual’s attorney come into possession of any recovery, upon his/her receipt of any such recovery, the covered individual’s attorney shall provide the plan administrator with written notice of the receipt of such recovery, including the amount and source(s) of the recovery, and shall not distribute any or all of such recovery to any person or entity other than the plan (including to the covered individual) until at least 60 days have passed after the date of the notice to the plan administrator.

No Duty to Independently Sue or Intervene

While the SCPMG Health and Welfare Plan’s right of subrogation includes the right to file an independent legal action or alternative dispute resolution proceeding against such third party (or to intervene in one brought by or on behalf of the covered individual), it has no obligation to do so.


To the extent that the plan makes a payment to any covered individual or beneficiary in excess of the amount payable under the plan to such covered individual or beneficiary, the plan shall have a first right of reimbursement and restitution with an equitable lien by contract in the amount of such overpayment.



The holder of any such overpayment shall hold such property as the plan’s constructive trustee. The plan’s rights of reimbursement and restitution shall in no way be affected, reduced, compromised, or eliminated by any doctrines limiting its rights (equitable or otherwise) such as the make-whole doctrine, contributory or comparative negligence, the common fund doctrine, or any other defense. The plan’s rights of reimbursement and restitution, and the covered individual’s or beneficiary’s obligation to the plan, shall also not be affected if the overpayment was made to another person or entity on behalf of the covered individual or beneficiary.

If any covered individual or beneficiary has cause to reasonably believe that an overpayment may have been made, the covered individual or beneficiary shall promptly notify the plan administrator of the relevant facts, shall not alienate any property that may be subject to the plan’s right of reimbursement or restitution, and shall cooperate with the plan and take any action that may be necessary to protect the plan’s interests as described in this SPD. If the plan administrator determines (on the basis of any relevant facts) that an overpayment was made to any covered individual or beneficiary (or any other person), any amounts subsequently payable as benefits under this plan with respect to the covered individual or beneficiary may be reduced by the amount of the outstanding overpayment or the plan administrator may recover such overpayment by any other appropriate method that the plan administrator shall determine.


In the event of a separation or dissolution of marriage, a court may issue an order directing one or more of your retirement plans to pay some or all of your retirement benefits for alimony, child support, or divided community property. Within a reasonable period after the plan receives the order, it will determine whether the order is a Qualified Domestic Relations Order (QDRO) and will advise you in writing of its determination, or it will ask a court to decide the question.

Until validity of the Domestic Relations Order is resolved, your interest in the plan, which is subject to the Domestic Relations Order will be segregated and may not be distributed. If a decision is made within 18 months, the account will be paid out in accordance with the QDRO. If the status of the Domestic Relations Order is unresolved after 18 months, your benefit will no longer be segregated and distributions may be permitted. If the order is later determined to be qualified, the order will apply prospectively.

For additional information about a QDRO for your Keogh Plan and the 401(k) Plan, including QDRO procedures and a model order that may assist you or your representatives in drafting a QDRO under the plans, contact the following:

Charles Schwab4150 Kinross Lakes ParkwayRichfield, Ohio 44286-5050Attn: QDRO Review



If the Keogh Plan or 401(k) Plan receive a Domestic Relations Orderregarding one or more of your retirement plans, you will be charged a processing fee that will be deducted from your account.

Qualified Medical Child Support Order

A Qualified Medical Child Support Order (QMCSO) creates or recognizes the rights of a child or other dependent of a participant who, by virtue of a Domestic Relations Order, is entitled to receive medical benefits through the participant’s coverage. You will be contacted by the Permanente Human Resources (PHR) Shared Services in the event a QMCSO is received by the plan administrator.

Such an order cannot require SCPMG to provide any type or form of benefit or any option that is not otherwise provided to the participant under the provisions of the plan.

If the plan receives a medical child support order for your child that instructs the plan to cover the child, the plan administrator will review it to determine if it meets the requirements for a QMCSO. If the administrator determines that it does, your child will be enrolled in the plan as your dependent, and the plan will be required to provide benefits as directed by the order. Coverage will continue for as long as specified in the order, or until coverage would otherwise end according to the terms of the plan.

You may obtain, without charge, a copy of the procedures governing QMCSOs from the plan administrator.

Note: A National Medical Support Notice will be recognized as a QMCSO if it meets the requirements of a QMCSO.

Statement of ERISA Rights

As a participant in any benefit plan sponsored by SCPMG, you are entitled to certain rights and protections under ERISA. ERISA provides that all pension and welfare plan participants shall be entitled to:

• Examine, without charge, at the plan administrator’s office, copies of all documents filed by the plan with the U.S. Department of Labor, such as detailed annual reports and plan descriptions.

• Obtain copies of all the plan documents and other plan information upon written request to the plan administrator through the plan administrator of each plan. The plan administrator may make a reasonable charge for the copies.

• Receive a summary of the plan’s annual financial report. The plan administrator is required to furnish each participant with a copy of the Summary Annual Report/annual funding notice free of charge.

• Continue group health plan coverage for yourself, spouse or dependents through the Consolidated Omnibus Budget Reconciliation Act of 1985



(COBRA) if there is a loss of coverage under the plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review this SPD and the documents governing the plan on the rules governing your COBRA continuation coverage rights.

• A reduction or elimination of exclusionary periods of coverage for preexisting conditions under your group health plan, if you have creditable coverage from another plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when you lose coverage under the plan, when you become entitled to elect COBRA continuation coverage, when your COBRA continuation coverage ceases, if you request it before losing coverage, or if you request it up to 24 months after losing coverage. Without evidence of creditable coverage, you may be subject to a pre-existing condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage.

• Prudent actions by plan fiduciaries. In addition to creating rights for plan participants ERISA imposes duties upon the people who are responsible for the operation of the benefit plan. The people who operate your plan, called “fiduciaries” of the plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one, including SCPMG or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a pension or welfare benefit or exercising your rights under ERISA.


Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report from the plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the plan administrator to provide the materials and pay you up to $156 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or federal court. In addition, if you disagree with the plan’s decision or lack thereof concerning the qualified status of a domestic relations order or a medical child support order, you may file suit in federal court. If it should happen that plan fiduciaries misuse the plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.




If you have any questions about your plans, you should contact PHR Shared Services. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the plan administrator, contact the nearest office of the U.S. Department of Labor, Employee Benefits Security Administration listed in your telephone directory, or the Division of Technical Assistance and Inquiries at the address below:


You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration at 1-866-444-3272.



GLOSSARY OF TERMS

306



GLOSSARY OF TERMSTerms related specifically to certain benefits are described in general in this section and are subject to change from time-to-time. Please keep in mind these are general descriptions of some terms used in this Handbook. Additional terms may also be used in this Handbook or in other documents. The actual terms and conditions of the benefits governed by ERISA are specified in the official plan documents, insurance contracts, or service agreements. In case of any omission or conflict between what is written in this Handbook and in the official plan documents, insurance contracts, or service agreements, the official plan documents, contracts, or agreements, as applicable, always govern.

For those terms used in benefit programs that are not subject to ERISA, (such as the paid time off benefits), in the case of any omission or conflict in this Handbook, the official plan document (if any), the SCPMG Partnership Agreement, SCPMG Rules and Regulations, the minutes of SCPMG’s Board of Directors, and the minutes of the Medical Directors, as applicable, always govern.

Also note that there are many other terms used in describing each benefit, which are defined in the specific section of this Handbook devoted to each of those benefits.

Actively at Work

Certain benefits require that you be actively at work for the coverage to take effect. Those benefits include Supplemental Medical coverage, Alternate Mental Health coverage, Disability coverage and Life Insurance coverage.

Actively at work is defined as:

• actively working full-time at your place of business or other location to which you are required to travel to perform your regular duties

• physically able to perform all such duties and

• regularly working the required number of scheduled hours per week.

Alcohol (or Alchoholism) and Chemical Dependency

Physical or psychological dependency, or both, on a controlled substance

or alcohol agent. Does not include conditions not attributable to a mental

disorder that are focus of attention or treatment, an addiction to nicotine

products, or food or caffeine intoxication.



Activities of Daily Living (ADL)

Basic activities of daily living generally consist of these self-care tasks: bathing, dressing/undressing, feeding, ambulating, maintaining continence, able to use toilet, and walking.

Anniversary Date/Year

The Anniversary Date is your benefits anniversary date for purposes of this Handbook and is your date of hire with any adjustments made for certain leave statuses and prior service credit. Your Anniversary Year is based on the Anniversary Date. Both affect service defined later in this section. The Anniversary Date is the date you first became an Associate Physician with any adjustment made due to leaves.

Associate Physician

Refers to an employee physician as defined in the SCPMG Rules and Regulations.

Base Compensation

The term Base Compensation is used for various benefits, including but not limited to life insurance and disability benefits. As of the date on the front cover of this Handbook, Base Compensation includes:

• starting base salary

• start base salary compensation adjustment

• standard longevity increases

• merit longevity and specialty/subspecialty merit longevity increases

• general compensation adjustments

• merit increases

• board certification stipend

• partnership status increase

• administrative stipend

Each of these components of Base Compensation is defined in detail in the SCPMG Partnership Agreement and Rules and Regulations. Additional pay for extra duty, Year-End Performance Draw, or other special compensation is not included in Base Compensation. Base Compensation is prorated to the work schedule.



Conversion Coverage

Conversion coverage is a type of health care or life insurance coverage offered to an individual who was previously covered. Policies that offer conversion coverage may not offer the identical benefits to those the individual had previously and may be more expensive than the individual’s group coverage with SCPMG. However, policies that offer conversion coverage do not generally require any medical evidence of insurability if the conversion application is made within the required amount of time.

Covered Earnings

Covered earnings means the greater of:

• 50% of your monthly Base Compensation as of the onset of disability prorated to your work schedule at that time (including compensation increases during the first six months of disability), or

• 50% of your average monthly gross compensation for the 12 months ending the June 30 or December 31 immediately preceding the onset of disability.

Refer to the Long-Term Disability Insurance section for more information.

Credited Service

Credited Service is time counted to determine the amount of your retirement income. Refer to the Common Plan Summary Plan Explanation or the Early Separation Summary Plan Explanation for more information.

Dependent Children

Dependent children are your children or the children of your spouse or domestic partner by birth, legal adoption, placement for adoption, or legal guardianship. In addition, dependent children include any child that is the subject of a Qualified Medical Child Support Order.

Domestic Partner

A domestic partner is a person living with you in a committed relationship who is not a relative, and with whom you share joint responsibility for each other’s common welfare. Only one person at a time can be enrolled as your domestic partner. Both you and your domestic partner must sign the appropriate affidavit.



Eligible Dependents

Eligible dependents are individuals who may be eligible for coverage under certain SCPMG benefits, including, but not limited to, the Kaiser Foundation Health Plan (KFHP), Supplemental Medical plan, Alternate Mental Health plan, and Dental Care benefits. Eligible dependents may include:

• your spouse or domestic partner and

• your spouse/domestic partner’s dependent children.

The age at which dependent children become ineligible for a benefit program depends on that benefit plan’s rules.

Remember, the definition of eligible dependents for each plan may differ and may also differ from the one used in determining your personal income taxes.

Refer to the specific sections on each benefit in this Handbook for more information.

Gross Compensation

Gross compensation is your monthly Base Compensation plus overnight and extra duty pay, but excludes amounts received as bonuses, awards, Imputed Income, or year-end performance draw.

Health Plan

Health Plan refers to Kaiser Foundation Health Plan, Inc.

Imputed Income

The cost of medical, dental, disability, life insurance benefits, and other applicable benefits paid for by SCPMG on behalf of each eligible Partner Physician and former Partner Physician. In certain cases, imputed income may also apply to Associate Physicians. Imputed Income is reported as taxable compensation to the physician.

Indexed Covered Earnings

For the first 12 months that monthly disability benefits are payable, Indexed Covered Earnings will be equal to Covered Earnings. After 12 monthly benefits are payable, Indexed Covered Earnings will be a Physician’s Covered Earnings plus an increase applied on each anniversary of the date monthly benefits become payable. The amount of each increase will be the lesser of: 10% of the Physician’s Indexed Covered Earnings during the preceding year of Disability; or the rate of increase in the Consumer Price Index during the preceding calendar year. Indexed Covered Earnings does not increase the disability benefit amount, however, it is designed to protect the physician’s eligibility under the 80% rule from being eroded by inflation.



Kaiser Permanente Multi-Site Plan

The Kaiser Permanente Multi-Site Plan is an alternative to KFHP for eligible retirees. The Kaiser Permanente Multi-Site Plan provides health care benefits if you reside outside of California but within the service area of other Kaiser Permanente participating providers. Refer to the Leaving SCPMG section of the Handbook for more information..

Medicare Part B Premium Reimbursement Program

Available to eligible retirees and their spouse or domestic partner who are Medicare eligible (age 65) and enrolled in the Kaiser Foundation Health Plan (KFHP). Retirees must meet the retirement criteria to qualify for this benefit, and Medicare must be assigned to KFHP. If eligible, SCPMG will reimburse the amount of Medicare Part B Premium to the retired physician and spouse or domestic partner.

Mental Illness

Any condition or disorder that carries with it a psycho-pathological diagnosis contained in the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association, irrespective of whether the condition or disorder has an identifiable congenital, hereditary, biochemical, or other physiological cause.

Plan (or plan)

Plan (or plan) generally refers to a specific benefit program provided be SCPMG, as applicable to the context in this Handbook. “Plans” generally refer to more than one plan provided by SCPMG, as applicable in the context.

Plan Administrator

The Plan Administrator for the plans governed by ERISA are defined in the Claims, Appeals and Administrative Information section of the Handbook. If Plan Administrator is used for a plan not governed by ERISA, then the Plan Administrator may be defined in the official plan documents, or as otherwise provided in other relevant documentation, such as the SCPMG Rules and Regulations.

Qualifying Service

Qualifying Service is time counted to determine if you are eligible for certain benefits. Qualifying Service includes both full-time and part-time (half-time or more) service, and can include periods devoted to certain other activities such as medical research and advanced study approved by the Plan’s Administrative Committee. Time spent in postgraduate training as an employee of Kaiser Foundation Hospitals does not count as Qualifying Service. In some cases, special rules apply so refer to each specific benefit plan’s requirements for additional information.



R & C

Reasonable and customary.

Senior Advantage

Senior Advantage refers to the Medicare Advantage contract between Kaiser Foundation Health Plan, Inc. and the Centers for Medicare and Medicaid Services, and is the health care coverage available for you and your spouse/ domestic partner generally upon reaching age 65 (if you are no longer working and are eligible for benefits).

Southern California Permanente Medical Group (SCPMG)

SCPMG is the plan sponsor of most of the benefits described in this Handbook. It is also referred to as Medical Group.

Summary Plan Description or SPD

Summary Plan Description. For the benefit plans governed by ERISA, this Benefits Handbook serves as your Summary Plan Description.

Special Dependents

Special dependents are eligible individuals who are covered for Health Plan benefits.

They include, but are not limited to your:

• parents, spouse’s parents, or domestic partner’s parents and

• over age children and their eligible dependents

Refer to the KFHP Special Dependent Coverage section of Health Care Benefits section for more information.

Spouse

Your legally recognized spouse. This definition does not include your legally separated or divorced spouse, even if the separation agreement or divorce decree/marital settlement agreement states that coverage must be provided.

Totally Disabled

Totally Disabled is used for disability and life insurance purposes. Refer to the applicable sections of the Handbook or review the insurance certificates for more information.



Year-End Performance Draw

Partner earnings represent the net income of Medical Group (i.e., the amount remaining after expenses are deducted from revenues). The paychecks that Partner Physicians receive every two weeks are considered an advance against Medical Group’s anticipated net earnings and do not include Year- End Performance Draw. Planned Year-End Performance Draw is the amount budgeted for distribution to the Partner Physicians following year end.

Refer to the SCPMG Rules and Regulations for more information.

BENEFITS HANDBOOK - KP

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